State policies on pharmacist-initiated PrEP and PREP usage

Background

To increase access and use of pre-exposure prophylaxis (PrEP), medications which serve as an effective prophylaxis for HIV, several U.S. states have permitted pharmacists to provide PrEP to patients independent from other providers. States have implemented this policy either by allowing pharmacists to serve as stop-gap providers by prescribing PrEP to patients for a limited duration, or by allowing pharmacists to fully provide these medications to patients without a time limitation.

Objectives

This study tested whether the introduction of these policies is associated with increased PrEP usage and whether any such effects on PrEP usage differed by whether pharmacists were authorized to prescribe PrEP for a limited or unlimited duration. This study tested whether both policy types were effective, neither, or a single policy type was effective.

Methods

The introduction of these policies is analyzed using a time-series cross-sectional regression model across all 50 U.S. states and the District of Columbia. The dependent variable was PrEP use per 100,000 state residents and the independent variables were the presence of specific pharmacist PrEP policies. State-level fixed effects were controlled for as were state-specific and national time trends.

Results

Allowing pharmacists to provide PrEP without time limitation is associated with an increase of PrEP of 25 users per 100,000 population, equivalent to 14% of the mean PrEP usage rate in 2023. Allowing pharmacists to serve as temporary providers of PREP is not associated with any increase in PrEP usage.

Conclusion

Allowing pharmacists to initiate the use of PrEP may be an effective way to promote the use of PrEP and achieve public health goals.