A Brief Look at Trends in HIV Care, Medication Use and Cost

Nov 29, 2017
Caring for patients with HIV, and keeping access to therapy affordable, is a priority for employers and plan sponsors that is challenged by increasing prices for therapy and high rates of medication nonadherence that could lead to drug resistance.
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Rochelle Article

Increased awareness, public health initiatives, and significant advances in treatment all have helped improve mortality and quality of life for people with HIV/AIDs, while reducing the prevalence of the virus in the U.S. Today, with proper disease management, HIV-positive individuals are living long and full lives. Even more encouraging, there is now medication available for preventing infection.

Caring for this patient population, and keeping access to therapy affordable, is a priority for employers and plan sponsors that is challenged by increasing prices for therapy and high rates of medication nonadherence that could lead to drug resistance.

Following is a brief look at HIV medication use, cost and trends in the U.S.

Preventive Care

A significant development in HIV management is the preemptive use of drugs to prevent HIV/AIDS, otherwise known pre-exposure prophylaxis, or PrEP, in people who have not yet been exposed to the virus (HIV negative), but who may be at substantial risk of contracting the disease.

The FDA approved Truvada® (emtricitabine/tenofovir disoproxil fumarate) for PrEP in 2012 and it’s currently the only medication indicated for the prevention of, and treatment of, HIV. While PrEP, along with public health prevention initiatives, is considered a powerful tool in combating HIV, people who use PrEP must commit to taking the drug every day and seeing their healthcare provider for follow-up every three months.

When examining utilization of Truvada, we found that a significantly higher proportion of commercially insured HIV patients were using it for prevention compared to Medicaid and Health Exchange patients. Nonetheless, the share of patients using Truvada for prevention in 2016 had doubled compared to 2015 across all three insurance types.

Moreover, those using Truvada for prevention were on average younger compared to those using Truvada for treatment. There is economic value associated with HIV prevention, with estimates indicating a discounted lifetime medical cost savings of over $229,000 per person.

Truvada Table

Adherence and rising medication costs – an ongoing challenge

As medications have become more effective, better tolerated and safer, their cost has dramatically increased. For example, although the population of patients with HIV comprises less than 1% among Health Exchange and Medicaid plans, HIV medications contributed to nearly 13% and 17%, of total drug spending, respectively. According to the Express Scripts 2016 Drug Trend Report, HIV is the costliest therapy class for both Exchange and Medicaid Managed Care plans; unit costs for the class increased 16% between 2015 and 2016 in both sectors.

Spending on HIV therapies is forecast to continue increasing annually over the next three years primarily due to unit cost trend. This cost trend is associated with wider prescribing of improved medications and new combination therapies.

Adding to these costs are adherence barriers. HIV treatment can be difficult to maintain, but successful therapy requires strict medication adherence, as even a brief lapse can require patients to switch to a different medication regimen due to the danger of developing drug resistance. Among patients with employer-provided coverage taking HIV therapy, nearly 24% were nonadherent to their medication in 2016. Nonadherence is defined as having a medication possession ratio (MPR) of less than 80%.

Looking to the future

Express Scripts is pioneering new, evidence-based solutions to help our members adhere to medications in order to stay healthy. Given the relatively low prevalence of patients with adequate viral suppression and high rates of nonadherence, there is still more to do to ensure that these lifesaving treatments are accessible and properly used to get the maximum effectiveness.

As the industry’s first actionable adherence solution, ScreenRx® combines early detection with tailored interventions to improve member adherence. ScreenRx identifies members new to an antiretroviral therapy and who are nonadherent to their antiretroviral medication and offers them tailored, proactive interventions from our HIV specialist pharmacists.

But we’re not stopping there. In our Express Script Lab, we’re developing a suite of solutions to assist plan sponsors in providing needed care at an affordable cost through innovation, focusing on new outreach to patients, member education programs, cost containment and clinical solutions.

Author Bio

Kiraat Munshi
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