4-16-25 Important PrEP Access Update
Once again, my particular field of medicine and the population we serve are in the headlines.
A lot is going on out there. Some of it may directly affect you. I am working hard to pay close attention and plan for the near future.
Please forward this email to anyone you know who takes PrEP for HIV prevention. (If you are a social media person – a link to this email text is on our drvitt.com website.) Insurance coverage for PrEP is under threat. The information below contains simple steps that one can take to ensure affordable access to this incredibly effective medication for preventing HIV.
The legal requirement for insurance companies to fully pay for HIV PrEP medication and related services is in jeopardy. The Supreme Court (SCOTUS) has agreed to hear Braidwood Management, Inc v. Kennedy, a case that challenges the Affordable Care Act's preventive services mandate. The plaintiffs argue that the US Preventive Services Task Force (USPSTF), which determines the preventive services insurers must fully cover without cost-sharing, was unconstitutionally appointed, in violation of the Appointments Clause. (Of particular note, the plaintiff's original argument was that covering PrEP violated their religious beliefs.) Arguments commence on April 21st. Click here for more detailed information.
If SCOTUS rules against the USPSTF, then PrEP medications and related services (i.e. testing) will likely no longer be fully paid for by your insurance, and will be cost-shared with the patient. Which means you will be financially on the hook until you have met your deductible/out-of-pocket maximum. If on a brand name PrEP drug (Descovy), we may see a resurgence of coupons and attendant red tape. If on generic Truvada (emtricitabine-tenofovir), you are at extreme risk of being ripped off by the insurance company/pharmacy benefit manager (PBM) industrial complex. Moreover, such a ruling would have wider implications across many fields of medicine.
Your potential solution will be to buy generic Truvada (emtricitabine-tenofovir) at the incredibly affordable price of $14/month directly from Mark Cuban Cost Plus Drugs. That is correct – $14 a month – plus a small shipping fee. (The price elsewhere can be over $1,500 a month!) You would pay directly, not with insurance, and outflank the opaque/corrupt pricing structure of the industry. I worked closely with Mark Cuban Cost Plus Drugs last year to bring generic penicillin G to the US market, ending a national shortage and also price gouging. They are a fantastic company, founded on the philosophy that generic drugs should be affordable to all and that pricing should be transparent. CPD is incorporated as a public benefit corporation, and has a maximum markup of only 15% on medications. I do not foresee anyone else stepping up like CPD has. (Note: I do not take a dime from CPD.)
Mark Cuban Cost Plus Drugs:
https://www.costplusdrugs.com/medications/emtricitabine-tenofovir-df-200mg-300mg-bottle-of-tablets/
A revolutionary new form of PrEP called lenacapavir, injected once every six months (!) could be approved later this year. This long-lasting injectable medication belongs to the new capsid inhibitor drug class. Data from the PURPOSE-1 and PURPOSE-2 trials demonstrate excellent effectiveness. The expected list price will be $42,000 a year. Gulp. In light of the uncertainty surrounding future insurance coverage for PrEP, it is impossible to know what the cost will be for patients.
Mpox case numbers in NYC remain low. Since January 1, 2025, 20 people in New York City have tested positive for mpox. There have been 3 cases in the last month (March 9, 2025 to April 5, 2025). Mpox vaccines are now primarily available at retail pharmacies. The two dose course constitutes full vaccination, and there is no indication for a third dose at this time.
DoxyPEP is a strategy for STI prevention in high-risk populations. Data from the DOXYVAC trial in France showed that post-exposure prophylaxis (PEP) with the generic antibiotic doxycycline (200mg dose taken within 72 hours of condomless sex) can reduce the incidence of chlamydia and syphilis even more than previously appreciated.
I recently gave a talk to the Compassionate Medicine Fellowship at Princeton. I always enjoy an opportunity to warp young minds. Topics included the primacy of the doctor-patient relationship, the history of HIV/AIDS in the US, working in East Africa with Doctors Without Borders, and the importance of an optimistic DIY outlook when fighting the corporate and bureaucratic entities that dominate the contemporary healthcare landscape. The kids were inquisitive and kind and will surely make great doctors someday.
For the 10th year in a row, our practice was honored with a New York Magazine/Castle Connolly Top Doctors listing. Thank you to colleagues and patients who nominated/participated.
Thank you for your referrals. In order to deliver the highest quality care, we must keep the patient panel small, and have a waiting list. Openings do become available from time to time. An inquiring friend can click here to complete the Interest Form.
Thank you for reading.
Your Doc,
EV
Eamonn A. Vitt MD
Direct Primary Care • Gay Men's Health
Board Certified Family Physician & HIV Specialist
Instructor in Clinical Medicine
Columbia University College of Physicians & Surgeons
NYU School of Medicine
30 Fifth Avenue, Suite 1E
New York, NY 10011
212-674-8777
info@drvitt.com
www.drvitt.com