Supporting Access to HIV Pre-Exposure Prophylaxis in a Shifting Financial and Insurance Landscape.

Introduction: Implementing HIV pre-exposure prophylaxis in the U.S. is critical to decreasing HIV transmission. However, regional disparities in pre-exposure prophylaxis use exist, with the southern U.S. having the lowest uptake relative to need. Community-based organizations in the South provide pre-exposure prophylaxis to many consumers, including those without health insurance.

Methods: The authors convened a community-building pre-exposure prophylaxis summit in April 2023 with representatives from diverse pre-exposure prophylaxis providers, including community-based organizations in Dallas, Texas, to evaluate the impact of recent changes in pre-exposure prophylaxis funding mechanisms on their capabilities to provide pre-exposure prophylaxis. Participants completed surveys (=17) and focus groups (=14 individuals in 2 groups).

Results: The authors found that reduced reimbursements from pre-exposure prophylaxis manufacturers have significantly altered the financial health of community-based organizations in Dallas, Texas, and jeopardized their capacity to provide pre-exposure prophylaxis. Community-based organizations reported difficulty in sustainably providing pre-exposure prophylaxis to uninsured clients because of fewer funds to cover unreimbursed costs for pre-exposure prophylaxis care. Many community-based organizations have diverted resources away from client outreach for pre-exposure prophylaxis and toward helping clients to enroll in commercial insurance plans that cover pre-exposure prophylaxis. These changes have further stressed community-based organizations by increasing the time spent by staff on managing prior authorizations for pre-exposure prophylaxis. Despite finding some success with workarounds, community-based organizations described continued financial fragility.

Conclusions: These findings suggest that fragmented funding streams jeopardize the ability of these vital organizations to continue providing pre-exposure prophylaxis services in a jurisdiction with high HIV incidence. Potential solutions include enhanced collaboration across community-based organizations and stable financial support from a national pre-exposure prophylaxis program.