A conversation about improving HIV PrEP access and adherence in managed care, with Julie Kendle, Pharm.D., senior director of clinical pharmacy at IPD Analytics

Preexposure prophylaxis (PrEP) is a preventive HIV medication for people who are HIV-negative but at high risk of infection. It currently comes in two forms: a long-acting injection or pills. When taken as prescribed, it is approximately 99% effective at preventing HIV.

Julie Kendle, Pharm.D., senior director of clinical pharmacy at IPD Analytics, recently sat down with Managed Healthcare Executive to share what managed healthcare organizations should be directing their attention to.

This interview has been edited for length and clarity.

MHE: What are the new and emerging long-acting therapies for HIV prevention, including their clinical efficacy, safety and adherence considerations?

Kendle: To give some context, the first PrEP product was approved in 2012. It was Gilead’s Truvada, which is available as a generic now. That was followed by Gilead’s Descovy in 2019.

They're typically considered easy to take, but sometimes people forget to take them. They do require daily administration. For a PrEP medication, compliance is important, because we know from clinical trials that when drug plasma levels drop, seroconversions occur.

That's where the newer, long-acting injectables come in. First, we had ViiV’s product Apretude, which was approved in 2021. It's an intramuscular injection that's administered every other month by a healthcare professional. Most recently, we had Gilead’s Yeztugo, which was approved in July of 2025. It is a subcutaneous injection that's administered once every six months by a healthcare professional. The advantage of long-acting injectables is that they alleviate that compliance issue that sometimes is associated with the daily oral medications. The injectables are also both really safe, with the main concerns for both being injection site reactions. They're injections — they're not necessarily comfortable to take, and because of their long-acting nature, there's sometimes a nodule that forms at the injection site that can hang around for a while.

MHE: What are the best HIV prevention health policies for managed care organizations interested in improving PrEP access and aligning with public health goals?

Kendle: The single most important policy is the U.S. Preventive Services Task Force (USPSTF) grade A recommendation for the use of PrEP in at-risk populations. The recommendation is that PrEP should be offered to all patients who are at risk, and because of the Affordable Care Act (ACA) and the USPSTF recommendation, most health plans in the United States are required to cover PrEP with no member out-of-pocket costs, along with other related services like office visits and testing. The recommendation also prevents plans from steering patients from one formulation of PrEP to another, which is broadly interpreted to mean that step therapy can't be used for this drug category, which is also relevant to payers. Besides that, Medicare also has a national coverage determination, or NCD on the topic, which provides coverage for all PrEP formulations, both oral and injectable, under Medicare Part B, and it gives Medicare beneficiaries essentially the same benefits offered under the ACA to commercial plans. In addition, we're seeing more states passing laws that pertain to PrEP access and coverage. There are some concerns right now about the stability of the USPSTF recommendation, so some states are creating mandates that would provide ongoing coverage of PrEP with no member out-of-pocket costs in the absence of a USPSTF recommendation. There are also more states permitting pharmacists to prescribe PrEP.

MHE: What are some managed care strategies to support patients at risk of HIV and to improve access, adherence and health outcomes?

Kendle: The patient PrEP journey is often described in three separate phases: initiation, access and adherence. Managed care strategies can be helpful in every one of those phases. In terms of initiation, they can help with identification of eligible patients. Integrated delivery systems have a bit of an advantage in this way, because they have access to a lot more types of medical records, but identification is also possible through some just very basic claims analysis as well. We also know that initiation is more successful when it's supported locally. So, partnership with community-based organizations, to whatever extent that's possible, can be vitally important to PrEP uptake, particularly among minority populations. In terms of access, managed care organizations can provide tools to guide members to appropriate resources for prescribing and testing. It's important to remember that prescribers can be physicians, but they can also be physician assistants, nurse practitioners or pharmacists, like I mentioned earlier. In terms of access to the long-acting injectables, they have some unique considerations. They probably aren't available at your local retail pharmacy, as much like the daily orals might be, so managed care plans really need to think through how patients can access these medications and who will be administering those medications to patients. That leads us to some medical benefit considerations: is the injection location in the preferred network? What's the member's copay or coinsurance for these types of services? Who facilitates the prior authorization process, if that applies? Is it the managed care organization, or is it a pharmacy benefit manager? Finally, in terms of the adherence and persistence journey, there are lots of electronic means of support today, like texts or email reminders about appointments and refills. There are even “tele-PrEP” at-home services that provide testing and counseling visits in the patient's home. Other considerations might include specialty pharmacy partnerships to support ongoing PrEP use, or even case management services to ensure that patients who start on PrEP stay on it and have successful outcomes. We know that somewhere between 20% and 25% of all patients that start PrEP end up discontinuing it within a few years, so it's really important that those ongoing services and supports are provided so that we can make sure that patients achieve the ultimate outcome.