Presentation (CTI)

OBJECTIVES: USPSTF guidelines recommend PrEP for individuals who may acquire HIV-1; following this recommendation, the Affordable Care Act mandated zero-cost sharing for PrEP-related ancillary healthcare services. We evaluated the effect of USPSTF guidelines on zero-cost sharing trends for PrEP ancillary services.
METHODS: USPSTF guideline adherence was assessed as percentage of zero-cost sharing claims (IQVIA-LAAD database; January 2019-August 2024) among PrEP ancillary services, including testing for HIV-1, sexually transmitted infections (STIs), hepatitis B/C, lipids, and creatinine, and counseling visits. Services were identified using CPT/HCPCS codes linked to PrEP use (Z29.81) or behaviors associated with HIV-1 acquisition (Z20.6, Z72.5X). Segmented regression in a time-series analysis compared the percentage of zero-cost sharing claims at pre- and post-milestone USPSTF guideline timepoints (initial Grade A recommendation [June 2019]; zero-cost coverage requirement [June 2020]; implementation clarification [July 2021]; Grade A recommendation [August 2023]).
RESULTS: For 64,866 individuals with 563,096 PrEP ancillary services in the USA, the number of claims and percentage of zero-cost sharing claims increased from 4695 (81%) in June 2019 to 14,382 (94%) in August 2023. Highest percentages of zero-cost sharing claims were for HIV-1 (87%, June 2019; 93%, August 2023) and STI testing (81%, June 2019; 96%, August 2023). Greatest increases in monthly zero-cost sharing between June 2019 and August 2023 were for creatinine testing (18%) and counseling visits (26%). Monthly zero-cost sharing claims increased over time for almost all services; however, complete adherence (100% zero-cost sharing) was not observed. Individuals in Midwestern states had 89% zero-cost sharing for HIV-1 testing versus 95% in Northeastern states. Medicaid beneficiaries had 97% zero-cost sharing for all services versus 89% for commercial insurance users.
CONCLUSIONS: This analysis highlights increasing adherence with USPSTF guidelines for PrEP ancillary services over time. Full implementation of zero-cost sharing remains incomplete; therefore, efforts are ongoing to improve adherence and overcome regional and payer-based disparities.