With the 26th annual World AIDS Day commemorated Dec. 1 across the globe by communities, governments and organizations, the Illinois Department of Public Health ( IDPH ) HIV/AIDS Inter-Agency Taskforce unveiled strategies for the implementation of a program to dramatically improve access and affordability of pre-exposure prophylaxis ( PrEP ) medication for at-risk individuals statewide.
Titled "PrEP for Illinois," plans were announced Dec. 3 as part of a taskforce meeting and discussion held with HIV advocacy groups and advocates from across the state at the IDPH offices in downtown Chicago.
PrEP is available in the form of the antiretroviral medications tenofovir and emtricitabine. The brand name Truvada is manufactured by the California-based biopharmaceutical company Gilead. When taken regularly prior to exposure to HIV, the U.S. Centers for Disease Control and Prevention ( CDC ) estimates PrEP at 92% effective in reducing the possibility of infection.
However, the cost of the medication has been a concern. In a document "summarizing the monthly out-of-pocket cost a person can expect to pay for Truvada," the AIDS Foundation of Chicago ( AFC ) referred to the 2014 Positively Aware HIV Drug Guide in averaging the wholesale price of Truvada at $1,539.90 per month before manufacturer and insurance assistancethe latter of which varies upon the level of an individual's plan.
Earlier this year, the Washington State Department of Health initiated the drug assistance program PrEP DAP. According to its website, the program was created for "HIV-negative people who have risk profile factors that expose them to HIV" and covers Truvada's co-pay for those with insurance or will pay the cost of the drug in full for those without coverage.
With the successful launch of the IDPH's initiative, Illinois will be the second state in the U.S. to roll-out such a program.
HIV/AIDS Section Chief for the IDPH Mildred Williamson summarized the Illinois program to Windy City Times. "We're incorporating PrEP content into our fundamentals training for organizations that we fund who do HIV testing and counseling," she said. "We're also sending a 'dear colleague' letter to medical providers around the state encouraging them to prescribe [Truvada] to high-risk persons they serve."
She added that the drug assistance portion of the program is in the pilot stage. "It's for people who maybe underinsured or not insured for whom we would collaborate with our dispensing pharmacy and the patience assistance program of the manufacturer," she said.
Williamson stated that the genesis of PrEP for Illinois emerged from studies demonstrating PrEP's effectiveness. "We learned, like everyone else, that the content of PrEP as a biomedical intervention needed to be incorporated into our work," she said. "Several things came together to make launching a pilot program possible. One was the implementation of the Affordable Care Act in Illinois. If people's incomes are low enough, we still assist with co-pays and deductibles but they tend to be less expensive than paying for the medication outright. Because we have cost-containment on our ADAP ( AIDS Drugs Assistance Program ), we were also eligible for some supplemental funding at the federal level."
During the meeting, IDPH staff noted that the "dear colleague" letter to healthcare providers informing them of the department's support of PrEP has been reviewed and approved. They hope that it will be signed this week and mailed shortly after. The IDPH has also drafted easy-to-understand PrEP guidance documentation to be finalized in the coming weeks for counselors to introduce to their clients as an option for risk-reduction prior to referral to a prescribing physician or agency. A training schedule has been tentatively laid out with fundamentals courses beginning in Chicago by February 2015.
The IDPH is creating a PrEP provider referral list for counselors as well as material for clients to use before approaching a medical provider.
The IDPH's Dr. Jeffrey Maras presented details of the program's infrastructure. "We're looking at working with our current technology providers to design a website for individuals to learn more about PrEP as well as being a platform where they can enroll into the PrEP for Illinois program if they have coinsurance," he said. "We will also have links for individuals who are uninsured that will maximize Gilead's patience assistance program."
Maras pledged a streamlined application process for those seeking PrEP assistance. "It will look very similarin a much reduced capacityto the Ryan White [another AIDS drug funding program] application," he said.
The form will help determine an applicant's required Illinois residency as well as their insurance status and demographic information. "We have been working with Gilead on how to interface their coinsurance program within our application process," Maras added
The IDPH hopes to launch the website by the middle of January 2015. Plans for PrEP for Illinois were received with a unanimous "Bravo" and applause from the attendees.
The AIDS Foundation of Chicago's Director of Prevention Advocacy and Gay Men's Health Jim Pickett echoed the sentiment to Windy City Times. "I'm just thrilled," he said. "There aren't many days I go to a random meeting giddy, but today I feel incredibly delighted at the leadership, the vision and the courage that the IDPH is showing. It's meeting such a huge need. As we're getting people enrolled into insurance and getting people covered, we still see folks with high cost-sharing and high deductibles for meds and services and this program is really going to help."
"There are lots of things that are still in motion," Williamson stressed. "We do not yet have a complete migration of people who are now eligible for other insurances and Medicaid. That's a gradual activity. We don't know what the demand [for the program] is going to be yet but we are setting up the infrastructure as best we can."
The meeting concluded with a reiteration of a World AIDS Day release by the IDPH regarding HIV funding opportunities for agencies interested in conducting "targeted HIV prevention and treatment engagement services." According to the IDPH, Quality of Life ( QOL ) grants will go to five to eight organizations and total $500,000a figure that is dependent upon sales of Red Ribbon lottery tickets.
Williamson addressed the problem with dispersal of monies connected to the grant-making process known as the African American AIDS Fund ( as reported in Windy City Times on 12/1/2014 ).
"When it was time to execute the grants, we learned there were no dollars in that line-item," Williamson said, "even though we were expecting that appropriation. Until that occurs, we can't do anything because we don't have the money available. We thought that it was going to be handled in this [legislative] session but we have received no information of anything having changed. We're waiting to hear from those who have the power to put money into the line-item."