Bottlenecks hamper PrEP prescribing

An HIV activist is urging doctors to increase pre-exposure prophylaxis for HIV (PrEP) prescribing

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An HIV activist is urging doctors to increase pre-exposure prophylaxis for HIV (PrEP) prescribing, as a growing community demand is being thwarted by a bottleneck in prescriptions.

Australian PrEP advocate, Rodney Ellis, said he expected the importing of the HIV prevention drug to rise after his PrEP buyers’ club negotiated a 30% lower price from an international supplier.

But the real bottleneck was getting enough prescriptions for people that wanted the medication, he said.

“We can handle whatever volume is coming through for online purchases,” he said. “We just need scripts.”

Last year, the TGA approved Truvada (emtricitabine/tenofovir), an antiretroviral therapy also used to treat HIV, as a preventative drug thanks to its almost 100% efficacy rate at preventing HIV transmission.

As a result, patients have been allowed to personally import the drug if they have a prescription.

Working with Green Cross Pharmacy, Mr Ellis secured a South African supplier which provides the three-month supply for around $150, compared with more than $210 being asked by Dynamix International.

As a founding member of the PrEP buyers’ club, PrEPaccessNOW, Mr Ellis said he was spurred to action after hearing men having to stop taking the drug due to a cost hike by Dynamix.

In a new campaign by ACON, the AIDS Council of NSW, PrEP was put forward as one of the key pillars in preventing HIV transmission, alongside condoms and antiretroviral medicines.

But Mr Ellis said that PrEP uptake could be a lot higher, and that misconceptions about the safety of the drug and its generics might be barriers.

Trials are under way in NSW and Victoria which have enabled thousands to get access to the once-daily pill under the current rules.

We can handle whatever volume is coming through for online purchases. We just need scripts.

However, this might have led to the perception that the drug was still experimental and that doctors were putting their patients at risk by providing a prescription, Mr Ellis said.

“Whereas it’s not at all,” he said. “It has been incredibly well researched.”

There had also been testing of generics to ensure that the drug was efficacious, he said.

“So far, we’ve had zero problems with any of the generics out there. Some of the generics [such as] tenofovir are actually FDA approved,” he said.

Prior to initiating PrEP, a patient needs to undergo tests to ensure they are HIV-negative and have normal renal function. Patients then need to be monitored every three months.

The Pharmaceuticals Benefits Advisory Committee rejected Gilead’s submission for a PBS listing for Truvada for PrEP last July.