After years of rising HIV rates, Florida health officials are taking an unexpected step. They’re offering preventative medication for free.
Pre-exposure prophylaxis (PrEP) is billed as a revolutionary medication for preventing the transmission of HIV. When taken correctly, it has been shown to reduce the risk of infection in individuals by up to 92 percent.
When combined with other safe sex practices, such as condoms, PrEP offers even greater protection for at-risk individuals.
Now, the Florida health department wants PrEP to be available at no cost to individuals at all 67 of its county health departments by the end of 2018.
“Ensuring pre-exposure prophylaxis (PrEP) to those at highest risk for HIV infection, regardless of their ability to pay, is one of the four key components of the agency’s plan to eliminate HIV transmission and reduce HIV-related deaths,” Devin Galetta, a spokesperson for the Florida Department of Health, told Healthline.
Access to PrEP is just one element of the state’s larger plan to combat HIV that they announced in December 2016.
In addition, health officials are also focusing on HIV and sexually transmitted infection (STI) screening, community outreach and education, and immediate access to treatment for high-risk populations.
The state’s initiative comes on the heels of a steadily increasing number of new HIV infections in the state. In 2014, Miami-Dade and Broward counties in Florida were the leading counties in the nation for new cases of HIV.
Gov. Rick Scott has also faced criticism of his handling of Florida’s growing HIV problem in recent years.
Cost is one of the obstacles
Increasing access to PrEP is an ambitious goal for the state.
The drug’s price point is just one aspect that makes it difficult.
According to PBS, the drug can cost $1,300 per month for individuals without insurance. However, the drug is covered by most insurers.
Gilead, the pharmaceutical company that created Truvada, the only PrEP medication currently on the market, also offers its own medication assistance program for low-income individuals.
Getting PrEP for free in Florida does come with a few hoops to jump through.
“Patients requesting PrEP services are evaluated clinically and if indicated, based on CDC clinical guidelines, are able to receive immediate access to PrEP medications. Consideration is then given to every patient based on their eligibility requirements, which includes their financial status, and assisting them with access to PrEP services,” Galetta said.
And PrEP isn’t just about getting a prescription either. Individuals taking it must get regular lab work done to ensure that the drug is working.
Courtney Mulhern-Pearson, senior director of policy and strategy at the San Francisco AIDS Foundation, told Healthline that additional doctor visits and lab work can lead to unforeseen costs for individuals taking PrEP.
“What we had been hearing from clients is that they were able to get the medication cost covered through Gilead’s program, but that these other costs were a significant barrier,” she said.
Going beyond PrEP
Florida’s program takes the step beyond just providing PrEP for free.
It also provides additional services, including HIV testing, PrEP and HIV education, liver function testing, and one follow-up doctor visit at three months.
However, it’s unclear if the program assists with additional lab work and other costs in perpetuity, or just when an individual starts on the state’s PrEP initiative.
A representative for the Florida Department of Health has previously gone on record as saying they don’t know how much the program will cost the state.
Other states, including Washington and New York have their own PrEP assistance programs. However, throughout the United States, these programs still remain quite limited.
“We think that PrEP is a revolutionary prevention tool and are doing everything that we can to make sure that our clients know about PrEP, and if they want to take PrEP, we lower as many barriers as we can,” says Mulhern-Pearson.
Getting the word out
Information about PrEP can still be quite limited, particularly for certain high-risk groups.
Individuals who are at the greatest risk of HIV transmission are also the ones least likely to know about PrEP.
“There are disparities in terms of who is on PrEP, and how much information people have about PrEP. There is a lot of room for growth and improvement in that area,” said Mulhern-Pearson.
“It kind of reinforces the disparities we see in who is getting infected,” she added.
Major public health initiatives like the one in Florida could be key to not just educating high-risk groups about PrEP, but also getting it into their hands by lowering cost and other barriers of entry.
“We want anybody who wants to access PrEP, to be able to access PrEP,” said Mulhern-Pearson.