The Downstream Impacts of High Drug Costs for PrEP Have Hindered the Promise of HIV Prevention - Kenyon Farrow

Sep 27, 2026

Uploaded by Mimi

Access to pre-exposure prophylaxis (PrEP) for HIV has been constrained by the downstream effects of high medication costs, even after generic TDF/FTC entered the U.S. market. Despite copay cards and patient assistance programs, the expected reduction in HIV diagnoses has not been fully achieved, and inequitable access persists. Evidence links high list prices to barriers in coverage, marketing, clinical eligibility, and prior authorization.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

AccessFree to download

Introduction

Racial and geographic disparities in PrEP uptake

List price impacts beyond out-of-pocket costs

Evidence from studies and policy criteria for PrEP scale-up

Congressional testimony and industry claims

The Downstream Impacts of High Drug Costs for PrEP Have Hindered the Promise of HIV Prevention Kenyon Farrow Keywords: PrEP, HIV, Drug Pricing, Disparities, Access Abstract: Prior to the recent introduction of generic TDF/FTC in the U.S., access to pre-exposure prophylaxis (PrEP) for HIV was greatly limited duetothe downstream e ects ofthe high cost of the medication. This article argues that despite drug copay cards and patient assistance programs, the promise of drastically reduced HIV diagnoses has never been fully realized, and more policy reforms on drug pricing are needed to make ending the HIV epidemic a reality. When tenofovir disoproxil fumarate/emtric itabine (TDF/FTC) was approved for the use of prevention of HIV in 2012 by the U.S. Food and Drug Administration, many saw it asa watershed moment that could move us toward truly ending the HIV epidemic in the U.S. and globally. But 10 years later, that has hardly happened. In the United States, the wealthiest nation in the world, the rollout of PrEP has been nothing short of an abysmal failure. Black people make up approximately 13% of the total U.S population, and about 44% of HIV diagno ses annually.1 Kenyon Farrow is an HIVprevention advocate and writer in Cleveland Heights, Ohio, USA. He is the Managing Director of Organizing and Advocacy with PrEP4ALL. He has also been using PrEP since 2015. He has a bachelor’s degree from Ohio Wesleyan University in Delaware, OH. And despite this disparity, we are also among the smallest population of people who are prescribed PrEP. According to a 2019 CDC analysis, only 11.2% of all PrEP users in the U.S. were Black.2 And while more than 50% of HIV diagnoses occur in the Southern states (which is still where most Black people in America live), most of the Southern states (except for Louisiana and Arkansas) have not expanded Medicaid under the A ordable Care Act. A 2020 study found that states that had expanded Medicaid and had a PrEP Access Program in the state had a 99% higher PrEP use than states that had neither, leaving many of the Southern states with large Black populations and large HIV prevalence rates with low access to PrEP and corresponding low usage.3 While many people place the blame of low PrEP use on the lack of knowledge, interest or initiative of the consumer, far less work has been done to assess the impact of the list price of the medication on the ability of users to access PrEP as well as stay on PrEP. Debates about drug pricing often come down to the amount a patient has to pay out of pocket when they ﬁll a prescription. But high drug list prices for antiretroviral medications, including those used for prevention, still impact access to these drugs downstream, even when the patient has low or no out-of-pocket costs. And while patient assistance programs can help cover some of those out-of-pocket costs for people who are not insured or cannot a ord the prescription co-pays, they have not been enough to increase equitable access. The high list prices of the initial brand name drugs for PrEP have dictated PrEP delivery systems in the U.S., including how PrEP was marketed, clinical guidelines to determine PrEP eligibility, and prior authorization requirements from payers. ﬁnancing and delivering pre-exposure prophylaxis (prep) to end the hiv epidemic • summer 2022 47 The Journal of Law, Medicine & Ethics, 50 S1 (2022): 47-50. © 2022 The Author(s) . This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ([https://creativecommons.org/licenses/by/4.0/](https://creativecommons.org/licenses/by/4.0/)), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: [https://doi.org/10.1017/jme.2022.35](https://doi.org/10.1017/jme.2022.35) The list price of PrEP medication and its impact on the ability to scale up use to have public health benefit was described in research li

FAQs

Why has PrEP access remained limited despite available assistance programs?

High drug list prices create downstream barriers in delivery systems, including marketing, eligibility rules, and prior authorization. Copay cards and assistance programs have not been enough to deliver equitable access.

How do disparities affect PrEP use in the United States?

Black people represent about 13% of the U.S. population but only 11.2% of PrEP users, based on a 2019 CDC analysis. Southern states with high Black populations often have not expanded Medicaid and show lower PrEP access and use.

What role does drug list price play beyond patients’ out-of-pocket costs?

Even when people face low or no out-of-pocket expenses, high list prices still influence who can access PrEP through payers’ requirements and other downstream mechanisms.

Sep 27, 2026

Uploaded by Mimi