Impact of covid-19 on prep prescriptions in the united states: A time series analysis

ABSTRACT

Background: On March 13, 2020 a national emergency was declared and protective measures were implemented in response to the COVID-19 pandemic. PrEP prescriptions had increased in the United States since 2014, but shutdown because of COVID-19 resulted in decreased use of health services. The objective of this study was to evaluate the impact of the COVID-19 on PrEP prescriptions in the United States. Methods: We analyzed data from the IQVIA Real World Data-Longitudinal Prescriptions Database from 2017 to the end of June 2020. Using a validated algorithm, we identified PrEP prescriptions and new PrEP users. We used a Bayesian structural time series model to predict the trajectory in PrEP prescriptions for the period of March 15-June 27, 2020 in the absence of the pandemic. The prediction was computed based on the pre-COVID-19 weekly PrEP data from January 1, 2017 to March 14, 2020 in the IQVIA database and adjusted for decreased PrEP prescriptions during holidays. The impact of COVID-19 was inferred by the differences between predicted and observed time series. We stratified the effect of COVID-19 on PrEP prescriptions by age group, insurance type, and among 10 states with most PrEP prescriptions prior to the national emergency declaration. Results: In the absence of the pandemic, our time series model predicted that there would have been 264,281 PrEP prescriptions during March 15-June 27, 2020 and we observed 222,589 PrEP prescriptions in the IQVIA database, a 15.8% reduction after the emergency declaration (Figure). The model predicted 43,636 new PrEP users during the same time period and we observed 29,971 new PrEP users, a 31.3% reduction after the emergency declaration. The impact of the pandemic on PrEP prescriptions was greater for those who paid for PrEP with cash (34.3% reduction in PrEP prescriptions;44.3% reduction in new PrEP users). The COVID-19 impact varied among the 10 states with the most PrEP prescriptions prior to the pandemic, ranging from 6.8% to 25.1% reductions in PrEP prescriptions and 19.8% to 48.1% reductions in new PrEP users. The number of new PrEP users began to increase towards the end of June 2020. Conclusion: Closures during the initial phase of the COVID-19 pandemic resulted in decreases in PrEP prescriptions and even more in new PrEP users. Ongoing monitoring is warranted to assess whether the impact has abated since June 2020. The reasons for decreased PrEP prescriptions could be lack of access to care or decreased risk behavior during the pandemic.