Three oral PrEP drugs have been approved by the FDA: branded tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) in July 2012, branded tenofovir alafenamide and emtricitabine (TAF/FTC) in October 2019, and generic TDF/FTC in July 2020. Long-acting injectable cabotegravir (CAB-LA) was approved in December 2021. We estimated trends in prescriptions for these PrEP drugs.
We analyzed IQVIA Real-World Data — Longitudinal Prescription Database (IQVIA) using a validated algorithm to identify persons prescribed antiretroviral drugs for PrEP. We estimated the number of persons prescribed branded TDF/FTC, TAF/FTC, generic TDF/FTC, or CAB-LA by month from January 2013 through June 2022. We estimated the proportions of prescriptions in June 2022 by type of PrEP drug. Among persons with an initial CAB-LA prescription from January through May 2022, we estimated the proportion who received a second prescription one month later. Among persons prescribed PrEP from January through June 2022, we estimated their demographic characteristics stratified by a prescription for oral PrEP or CAB-LA.
We found that the number of persons prescribed branded TDF/FTC increased from January 2013 until October 2020 and then decreased markedly each month after TAF/FTC and generic TDF/FTC became available (Figure). Beginning in December 2021, the number of persons prescribed generic TDF/FTC exceeded the number prescribed TAF/FTC each month. In June 2022, 177,293 persons were prescribed PrEP; 89,654 (50.6%) were prescribed generic TDF/FTC and 80,754 (45.5%) TAF/FTC; only 804 (0.5%) were prescribed CAB-LA. From January through May 2022, among 800 persons who picked up their CAB-LA prescription 633 (79.1%) received a prescription for a second dose. During January through June 2022, women comprised 11.5% of persons prescribed CAB-LA compared with 6.4% of persons prescribed oral PrEP.
Most PrEP users were prescribed generic TDF/FTC and very few were prescribed CAB-LA since its recent approval. The increasing proportion of generic TDF/FTC prescriptions compared with TAF/FTC is encouraging and can result in lower healthcare expenditures for PrEP, yet a large proportion of prescriptions were for the more expensive TAF/FTC. Better understanding is needed of reasons for low uptake of CAB-LA, including of operational barriers to its implementation. Studies are also needed to understand factors associated with CAB-LA use among women to inform implementation efforts.
Figure. Persons prescribed PrEP by type of PrEP drug, IQVIA Real-World Data — Longitudinal Prescription Database — United States, January 2013 through June 2022