This document analyzes trends in pre-exposure prophylaxis (PrEP) utilization from 2012-2015 using national electronic patient data from pharmacies. It finds that 79,684 individuals received PrEP, with family medicine, internal medicine, infectious diseases, and emergency medicine accounting for 84% of prescriptions. For males, family medicine and internal medicine were the primary prescribers, while for females it was emergency medicine and family planning. Starts for males were most commonly covered by commercial insurance and Medicaid, while females were mostly covered by Medicaid. The results indicate gender differences in PrEP prescribers and insurance coverage that have implications for linking patients to prevention services differently for men and women.

1. Provider Specialty and Payor Type Trends in
Pre-Exposure Prophylaxis (PrEP) Utilization: 2012-2015
MK Rawlings1
, D Magnuson2
, T Hawkins1
, S McCallister3
, R Mera Giler4
1
HIV Medical Affairs, 2
Drug Safety, 3
Clinical Research, and 4
Epidemiology Gilead Sciences, Foster City, CA
Background
© 2016 Gilead Sciences, Inc. All rights reserved.
M. Keith Rawlings, MD
333 Lakeside Drive
Foster City, CA 94404
email: keith.rawlings@gilead.com
11th International Workshop on HIV Transmission, Chicago, Illinois, October 15-16, 2016
HIV Research for Prevention (R4P 2016), Chicago, Illinois, October 17-21, 2016
♦♦ A total of 79,684 unique individuals (24%
female) were started on FTC/TDF for PrEP by
over 120 different medical subspecialties
♦♦ Four specialties, Family Medicine (FM), Internal
Medicine (IM), Infectious Diseases (ID) and
Emergency Medicine (EM) accounted for 84%
of all starts
♦♦ Among males FM (35%) and IM (28%) were the
2 primary prescribers. For females, EM (25%)
and FP (23%) were the 2 primary prescribers
♦♦ Starts in men were most commonly covered
by commercial plans (62%) and Medicaid
(16%). For women the most common payor
was Medicaid (45%) with commercial plans
accounting for (33%) of starts
Utilization by Gender and Provider Specialty
♦♦ Over the last few years, the availability of
FTC/TDF for PrEP, in combination with other
strategies to reduce the risk of sexually
acquired HIV-1 in adults at high risk, has
altered the HIV prevention landscape in the US.
Previous analysis has shown gender (Flash,
HIV Drug 2014) and racial (Bush, ASM 2016)
differences among individuals started on FTC/
TDF for PrEP. Here we describe characteristics
and differences in utilization by payor type and
provider specialty.
♦♦ National electronic patient level data was
collected from 80% of all US retail pharmacies
that dispensed FTC/TDF between January 1,
2012 and December 31, 2015. A previously
described algorithm identified use of FTC/
TDF for PrEP. De-identified patient and
provider demographics, prescription refill data
and medical claims were analyzed through
categorical methods. Data was analyzed by
payor type and provider specialty.
♦♦ All analyses were carried out using STATA 13
(College Station, TX).
♦♦ Flash C, Landovitz R, Giler RM, Ng L, Magnuson
D, Wooley SB, Rawlings K. “Two years of
Truvada for pre-exposure prophylaxis utilization
in the US.” Poster P198, HIV Drug Therapy,
Glasgow, UK, November 2014
♦♦ Bush S, Magnuson D, Rawlings MK, Hawkins
T, McCallister S, Mera Giler R. “Racial
Characteristics of FTC/TDF for Pre-Exposure
Prophylaxis Users in the US”. Oral abstract
2651, ASM Microbe 2016, Boston, MA June
2016
♦♦ Mera R, McCallister S, Palmer B, Mayer
G, Magnuson D, Rawlings MK. “FTC/TDF
(Truvada) for HIV Pre-Exposure Prophylaxis
(PrEP) Utilization in the United States: (2013-
2015)”. Oral Late-Breaker TUAX0105LB, 21st
International AIDS Conference (AIDS 2016),
Durban, SA, July 2016
Male Female
Female Utilization by Region and Provider Specialty
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
Emergency Medicine
Family Medicine
Infectious Disease
Internal Medicine
Utilization by Gender and Payor Type Specialty
Male Utilization by Region and Provider Specialty
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
45.00%
Emergency Medicine
Family Medicine
Infectious Disease
Internal Medicine
25.7%
23.6%
1.5%
14.5%
12.2%
1.4%
2.5% 6.0%
12.6%
6.7%
35.8%
1.3%
13.7%
28.7%
1.1%
1.2%
1.0%
10.4%
EM
FM
GEN
ID
IM
NP
OBGYN
PED
Other
Male Female
Materials & Methods
Results
Results, cont. Discussion
References
* Includes Medicaid Managed Care and Fee-for-Service
16.0%
3.6%
4.5%
62.1%
13.8%
MEDICAID*
CASH
MEDICARE
COMMERCIAL
OTHER
44.8%
6.1%8.5%
32.1%
8.5%
11th International Workshop on HIV
Transmission
Poster Number: P-30
October 15-16, 2016
Chicago, IL
HIV Research for Prevention (R4P 2016)
Poster Number: P09.25LB
October 17-21, 2016
Chicago, IL
♦♦ Our analysis shows gender
differences in which medical
specialties prescribe, and the
payment type that cover, FTC/TDF
for PrEP.
♦♦ There do not appear to be
regional differences in the medical
specialties that prescribe.
♦♦ A higher level of commercial plan
coverage for males, and a greater
proportion of starts among women
by Emergency Medicine providers,
have potential implications for
linkage to prevention services and
the implementation of FTC/TDF for
PrEP in clinical management.
♦♦ Additionally, these finding highlight
the need for different strategies for
prescriber education and access
to prevention care for men and
women.