A groundbreaking drug assistance program by the Washington State Department of Health will help pay for an expensive daily pill that could reduce the chance of HIV infection. The program is targeted at state residents who are at high risk of infection.
The Pre-E xposure Prophylaxis Drug Assistance Program, or PrEP DAP, covers the cost of the medication for eligible individuals interested in using it to reduce their chance of HIV infection as prescribed by their doctors, regardless of whether they are insured. PrEP, or pre-exposure prophylaxis, comes in the form of a daily prescription pill, Truvada, and costs about $1,300 per month — an obstacle for many who seek the medication with insurance, and especially the uninsured.
Participants in the Washington program pay nothing.
David Kern, manager of the Infectious Disease Prevention Section at the Washington Department of Health said he is unaware of any other states with programs specifically providing financial support for PrEP, but that someday it could serve as a model for state public health officials across the country.
"In Washington, we really see PrEP as a new and important tool in the toolbox for HIV prevention," Kern told BuzzFeed. "It is a strategy that supports our overarching public health goals and it's an important part of what we're doing with resources."
Washington health officials — just like the Centers for Disease Control and Prevention and the World Health Organization — have identified PrEP as an effective means of preventing new HIV infections in addition to using condoms, but with that, the state found that increasing access to the drug is among strategic priorities in its fight against HIV, particularly among men who have sex with men in urban communities. Washington hopes to reduce new HIV infections statewide by 25% by 2016.
In May, the Centers for Disease Control and Prevention (CDC) issued guidelines to medical providers, saying PrEP could reduce HIV infection when taken daily by more than 90%. And this month, the World Health Organization said men who have sex with men should consider PrEP alongside the use of condoms as another method of HIV prevention.
So far, the program has seen a "very soft" launch, since it was announced in early April with the DOH teaming up with local health organizations to mobilize patients who may need the financial assistance, according to Kern. As of July 22, there are only 17 active participants, the majority of whom are gay men ranging in age and ethnicity, but Kern said there has been a big uptick in interest in recent weeks.
Financial support includes all of the costs of the medication for participants who are uninsured, underinsured, and even for people with insurance, so that there is no cost of the pills out of pocket. For those with insurance, the provider is billed first and then the program covers the co-pay, which is about $450 per month on average, Kern said. For clients without insurance, PrEP DAP covers the entire $1,300 monthly cost of Truvada. The PrEP DAP does not cover lab work costs and medical visits.
Fred Swanson, executive director of Gay City Health Project in Seattle, a leading provider of HIV and STI testing in Seattle, said the Washington PrEP DAP program answers the question for people who are seeking to access PrEP and don't know how to pay for it.
"Cost is one of the biggest barriers to PrEP," Swanson said. "Even with the Affordable Care Act, people are choosing plans that still require really large co-pays, so when they go to access PrEP, it's not really plausible for them. We have seen that even people with insurance aren't able to afford the prescription."
Swanson said Gay City Heath Project offers application forms to the program and informs clients of the available financial assistance from the state so that they can discuss PrEP with their doctors and know how to pay for it. With that, Swanson said they are also seeing an increase in interest surrounding PrEP over the last few months.
"There's been a definite shift," he said. "I think there were just a lot of questions and a lot people not quite sure about it because of concerns with side effects and other concerns, but we've reached some sort of tipping point and I think it's a combination of community education and the CDC guidelines, the World Health Organization recommendations — all of those things add together."
Eligibility in the assistance program is limited to Washington state residents who are HIV negative and declare certain risk factors, Kern said.
Gay and bisexual men and other men who have sex with men are eligible if they've met one or more of five criteria: if they have been diagnosed with a bacterial STI in the last year, if they were exposed to an STI from sexual partners in the last year, if they've had 10 or more sexual partners in the last year, used methamphetamine in the last year, or have had unprotected anal sex with someone of unknown HIV status. Individuals who are in a sexual relationship or share needles with someone who is HIV positive are also eligible.
"Unless someone marks 'no' to all of those conditions, they are eligible," Kern said. "We wanted to have as broad of coverage as possible and not stifle interest."
Kern expects the program to "get up to speed" in the coming months and increase the number of participants, which the DOH has planned to leave unrestricted, assuming the state's budget for it remains at its current $1 million to $2 million. The department will then review the program after the first 100 participants or after about six months. Kern also noted the budget comes from state resources and not federal funding.
The DOH also provides funding for the Public Health STD Clinic at Harborview Medical Center in Seattle, which offers a PrEP clinic service where patients who are interested in PrEP could talk to doctors about getting a prescription. Additionally, the DOH is leading public education initiatives on PrEP.
"I don't imagine that our PrEP DAP program will ever be the primary payer of PrEP services in the state, but because the state has taken an interest and is communicating that we do care and will make resources available for this intervention, it lets people know that the state Health Department endorses the prevention option and hope we reach communities with it."
And ultimately, Kern said the DOH hopes that Washington's commitment to utilizing PrEP as a key HIV prevention strategy will motivate other states and local health departments to make similar commitments if they can.
"We believe that PrEP DAP can definitely serve as a model for states that are interested in setting up a similar system, i.e., paying for PrEP medications," Kern said via email. "Having said that, we recognize that many states depend heavily (and sometimes exclusively) on federal funding to support their HIV programs. Currently, federal funding cannot be used to purchase PrEP medication, so it's not possible for some jurisdictions to provide this program."
Kern, again emphasized the importance of PrEP, saying, "We need all public health colleagues to promote and support it."
Swanson's organization is Gay City Health Project. An earlier version of this item misstated its name.