National Study to Assess the Reach and Public Health Impact of Pharmacist-Prescribed PrEP

About This Grant

PROJECT SUMMARY P HIV Pre-Exposure Prophylaxis (PrEP)harmacist autonomous-prescribing of is an HIV prevention strategy that is rapidly rising in the US – the number of states with pharmacist-prescribed PrEP has over quintupled in the past five years andPrEP prescribing by pharmacists increased doubled within four years of the first state policy. Yet, studies of this HIV prevention strategy have been concentrated in a few cities and the impact of these policies have not been evaluated. Thus, we lack rigorous national data about when, where or to whom pharmacists are prescribing PrEP, whether it is happening in areas where PrEP is most needed, or the public health impact it might be having on PrEP adherence, persistence, or subsequent HIV rates. This study’s primary purpose is to evaluate, on a national level, where pharmacist-prescribed HIV PrEP is happening or not happening within states that allow it, who it reaches, and what population-level impacts it is having on HIV. Our team was the first to identify a novel population-based surveillance metric of PrEP adherence using national pharmacy claims data, finding that nearly 1 in 5 patients with an insurance-approved, new, oral PrEP script who did not pick up PrEP from their pharmacy, of which, over 70% still did not pick up PrEP within 365 days, conferring up to 5 times higher HIV risk than those who picked up PrEP consistently. We then assessed non-adherence for by the specialty of prescribing provider, but we could not assess pharmacists as a group of providers, as legislation for pharmacist-prescribed PrEP was too new for that earlier 2019 data capture. We now embark on a timely investigation of pharmacist-prescribed PrEP, to better understand where it is happening or not happening, what populations are best reached by pharmacists, and HIV rates of patients prescribed PrEP by pharmacists compared with other prescribers. We use a nationally representative claims dataset (IQVIA) that captures ~85% of all PrEP prescriptions in the US, including public, private and individual payers, along with patient demographics and National Provider Identifier, linked to prescriber data from the National Plan and Provider Enumeration System to: compare trends and timing of pharmacist-prescribed PrEP to other prescribers, mapping to where PrEP need is high (i.e., high HIV incidence) but allowed pharmacist- prescribing is not happening (Aim 1); identify the profile of patients most reached by pharmacist-prescribed PrEP (Aim 2); and compare PrEP adherence, persistence, and HIV incidence at one year, among those prescribed by pharmacists versus other prescribers (Aim 3) as an indicator of whether patients remain engaged in PrEP care after initiation at pharmacies. Our team includes expertise in epidemiology, pharmacy, biostatistics, GIS, and HIV prevention. The study has policy implications for how pharmacists are engaged in care, and where care needs to be expanded based on populations being underserved, with the expected outcome of fully integrating pharmacists into HIV prevention.