Sexual healthcare provider TBD Health unveiled a subscription program for the daily HIV prevention medication pre-exposure prophylaxis (PrEP) on Tuesday.
The subscription, which is not covered by insurance, costs $149 every three months after the initial purchase of $299. It will include at-home sexually transmitted infection (STI) and HIV testing and access to telehealth consults, along with the prescription. The company hopes to get insurers on board to cover its services, TBD co-founder and co-CEO Daphne Chen told Healthcare Brew.
“We want to see that this is a service that resonates with people. And that we are starting to see some of the demographic shift away from the main adopters of PrEP being just men who have sex with men, or men who identify as gay men, and [that we are] really helping everybody understand that if you are having unprotected sex, you might be a good candidate for PrEP,” Chen said.
Though the medicine is historically prescribed to men who have sex with other men, TBD Health is promoting it by emphasizing that many patients, regardless of gender or sexual orientation, can benefit from PrEP. Anyone who has unprotected sex or sex with multiple partners can benefit from PrEP, TBD nurse practitioner Adrienne Ton told Healthcare Brew.
By targeting a larger demographic of patients who would benefit from PrEP, TBD hopes to increase its customer base and also bring in patients who may turn to TBD for other sexual health offerings, such as the company’s STI panel testing kits which have seen “strong growth,” Chen said.
PrEP is available for patients who have had sex with a partner with HIV or an unknown HIV status, have not consistently used condoms, have been diagnosed with an STD, or have shared needles, syringes, or other equipment for injecting drugs in the last six months.
Across other telehealth PrEP companies, the main clients are cisgender men in their 20s and 30s who have sex with other men, according to a 2022 issue brief from Kaiser Family Foundation (KFF). Rates of HIV, however, are rising among patients who reported having heterosexual sex, making up slightly more than 20% of new HIV cases in 2020, according to the Centers for Disease Control and Prevention (CDC).
Under the Affordable Care Act, many insurers cover PrEP for free. A PrEP subscription from TBD can be an option for patients who have inconsistent insurance coverage or are in between plans, Chen said. With a prescription, patients have access to TBD’s medication cost discount programs to help “find access to the most cost-effective medication,” Chen said.
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To start the subscription with TBD, patients first fill out an intake form and complete the initial at-home testing. Before starting PrEP, patients test for HIV, Hepatitis B and C as well as other STIs, and pregnancy (if applicable). The patient then meets virtually with a TBD clinician, who prescribes the medication and sends it to the patient’s preferred pharmacy for same-day pickup. To maintain the subscription, TBD sends patients an at-home HIV testing kit every three months.
“It’s a fairly simple treatment. But at the same time, you want to make sure that it’s safe for you, and so that’s where the clinicians come in to help,” Ton said. “There’s always that opportunity for ongoing education or questions that come up or just little check ins on ‘Hey, should I be having this side effect?’ We want to really make sure that people feel supported in this program.”
In 2020, about 25% of eligible patients were prescribed the medicine, up from 3% in 2015, according to the CDC. However, despite the moves to make PrEP more readily available, patients still face barriers when accessing the medicine. One reason for the lack of access is that some patients are unable to schedule regular appointments with an in-person provider to maintain their prescription due to lack of appointment availability, Chen said.
TBD currently sends at-home test kits to patients across all states except for New York. New York prohibits self-collected tests unless approved by the state lab’s Clinical Laboratory Evaluation Program, meaning patients who receive PrEP through telehealth providers still need to visit in-person labs for HIV testing, according to KFF.
“That means that it doesn’t matter where you live: If there is a provider that’s in your district or town that’s able to serve you—which is a toss up [as] some places don’t have access to doctors who can provide PrEP—we’re able to support you no matter where you are,” Chen said.
The company raised $4.4 million in seed funding earlier this year to expand their services to almost every state, according to a January announcement. TBD has one in-person clinic in Las Vegas and plans to open new locations in Colorado and other regions this fall, Chen said.