Poster #42 - Expanding Pharmacist Scope of Practice for PrEP: Evidence from National Claims Data

• In Event: Saturday Poster Luncheon

Abstract

Access to pre-exposure prophylaxis (PrEP) is critical to reducing new HIV infections in the United States, yet uptake remains limited. For example, in 2022, only 36% of the approximately 1.2 million individuals who could benefit from PrEP were prescribed it. Despite a significant increase in PrEP prescriptions since its approval in 2012, PrEP initiation and retention remain low, resulting in suboptimal benefits. Nearly 1 in 5 patients newly prescribed PrEP delayed initiation, and only about 50% of patients who initiated PrEP were still on it six months later. Expanding provider roles and diversifying care delivery settings are promising strategies to address persistent access barriers. Reflecting this, the 2022–2025 National HIV/AIDS Strategy highlights pharmacists as key providers in HIV prevention. As of January 2026, 14 states have enacted scope-of-practice (SOP) laws allowing pharmacists to independently initiate PrEP without a physician’s prescription. Pharmacies, however, are not required to participate. For example, in California, only 11 percent of pharmacies offered pharmacist-prescribed PrEP two years after the statewide standing order was implemented, in part due to implementation barriers. Constraints on pharmacist-initiated PrEP vary across states and include training requirements before the pharmacist may distribute PrEP, limitations on how much PrEP the pharmacist may dispense to a single patient, prior authorization requirements, and inadequate reimbursement for their services. This study provides causal evidence on the effectiveness and equity implications of pharmacist SOP expansions. We leverage a large, national pharmaceutical claims database that captures the majority of PrEP prescriptions and is linked to medical claims and patient demographic information. Using a quasi-experimental design, we estimate the impact of SOP laws on PrEP initiation, prescription abandonment (failure to pick up within 365 days), retention in care (guideline-concordant follow-up visits and prescription renewals for oral and injectable PrEP), and new HIV diagnoses. Outcomes are measured across care settings, distinguishing between pharmacy- and clinic-initiated PrEP. We further assess heterogeneity in policy effects across racial and ethnic groups, sex, age, and geographically defined healthcare deserts, and compare impacts across states to identify contextual factors associated with greater policy effectiveness. By generating rigorous, real-world evidence on pharmacist-led PrEP delivery, this study informs ongoing policy efforts to expand access to HIV prevention services and reduce disparities in PrEP uptake.

Author

• Bita Fayaz Farkhad, University of Pennsylvania
  Presenting Author