According to the Centers for Disease Control and Prevention, transgender non-conforming people are at high risk for HIV. Amida Care has been a Medicaid Special Needs Plan in New York City for the HIV-positive population only, but in November 2017, the plan was permitted to enroll HIV-negative individuals who are transgender or homeless who may be at risk for acquiring HIV. Researchers used claims data to assess utilization patterns of pre-exposure prophylaxis (PrEP) in this high-risk patient population. The results of the study were presented during AMCP eLearning Days in a poster presentation titled “Characteristics of Pre-Exposure Prophylaxis Utilization in Transgender and Homeless Medicaid-Covered Patients in New York City.”
Researchers assessed the utilization of emtricitabine/tenofovir disoproxil fumarate for PrEP in Medicaid members at high risk of HIV infection living in New York City via pharmacy claims data. They identified members who filled one or more 30-day prescriptions for PrEP between January 1, 2018, and September 30, 2019. Plan data were used to identify those who were HIV-negative, transgender non-conforming, and/or homeless, and researchers assessed demographic data, including member age, gender, ethnicity, and enrollment status.
In 2018 there were 349 unique HIV-negative members enrolled, 24% of whom 24 (n=82) had filled one or more PrEP prescriptions. In the nine months of 2019 studied, 527 unique HIV-negative members were enrolled, 26% of whom (n=135) filled a prescription.
A total of 935 prescriptions were filled during the study period—295 in 2018 and 640 in the first three quarters of 2019. Most prescriptions (47%) were filled in a pharmacy in Manhattan, 23% were in the Bronx, and 20% were in Brooklyn. Overall, 161 unique members filled PrEP prescriptions: 71% (n=115) identified as transgender non-conforming, 4% (n=7) were cisgender homeless, 11% (n=17) were both, and 14% (n=22) had a pending status confirmation.
Of the members on PrEP, 20% were black, 11% were Hispanic, 7% were multiracial, 7% were white, and 55% were other/unknown. Mean age of those who filled a PrEP prescription was 32 years (range, 19-60 years). On average, 15% of the actively enrolled population filled PrEP each month.
“Further analysis is needed to assess PrEP persistence through evaluating health care gaps and identifying clinical interventions specific to the needs of the transgender non-conforming and homeless population,” the researchers concluded.
The study was sponsored by Amida Care Health Plan.
Baja M, Malek M, Ng K. Characteristics of Pre-Exposure Prophylaxis Utilization in Transgender and Homeless Medicaid-Covered Patients in New York City. Abstract B2. Presented during AMCP eLearning Days, April 20-24.