About News New Research Finds 'Systemic Barrier' to HIV Prevention in Southern States Aug 05, 2020 Josh Barney New Research Finds 'Systemic Barrier' to HIV Prevention in Southern States The South, the U.S. region with the most HIV infections each year, also has the greatest barriers to obtaining drugs that can prevent the disease for people who rely on Affordable Care Act insurance plans, research reveals. University of Virginia School of Medicine researchers have found that 38% of qualified health plans offered by Southern states require recipients to seek “prior authorization” for the prescription medications. That rate is far higher than in other regions, which range from 13% in the Midwest down to only 3% in the Northeast. Outlining their findings in a paper in the journal JAMA Network Open, the researchers said that “discriminatory benefit design” that seeks to prevent people from accessing costly medical care could be a “systemic barrier” contributing to the spread of HIV in the South. PrEP (pre-exposure prophylaxis) medications are preventative medications for people at higher risk of contracting HIV – either because of sexual activity or other factors. When insurance plans require prior authorization, doctors must justify a drug as medically necessary and may have to document that the patient meets specific criteria. “Qualified health plans using prior authorization for HIV pre-exposure prophylaxis at higher rates in the South is a systemic barrier,” said researcher Dr. Kathleen McManus of UVA’s Division of Infectious Diseases and International Health. “Prior authorizations have been cited by clinicians as being one of the biggest barriers for PrEP uptake. For other medications, prior authorizations have been shown to decrease appropriate medication use. If someone lives in the South, they are more likely to face this barrier than someone who lives in the Northeast. This is problem because more than half of the United States’ annual HIV diagnoses are in the South. The South is the region where we need increased PrEP uptake in order to curb new HIV infections.” “This policy is an example of structural racism,” she said. “More than half of African Americans live in the South, where they are more likely to face this barrier, and the lifetime risk of acquiring HIV for African American men is one in 20, compared to one in 132 for white men. The lifetime risk of acquiring HIV for African American women is one in 48, compared to one in 880 for white women.” Read in UVA Today Sebastian Tello-Trillo Sebastian Tello-Trillo is an economist whose research focuses on health policy in the U.S and Latin America. Most of his research focuses on understanding how policies affect individuals’ health behaviors and economic outcomes. His fields of specialization are in Health Economics and Applied Microeconomics. Read full bio Related Content Sebastian Tello-Trillo Losing public health insurance: TennCare reform and personal financial distress Research Batten Professor Sebastian Tello-Trillo and his co-authors write about how the primary goal of health insurance is smoothing the financial risk associated with health shocks. They estimate the effect of exposure to health-insurance reform on individual-level financial well-being. Regional Disparities in Qualified Health Plans’ Prior Authorization Requirements for HIV Pre-exposure Prophylaxis in the United States Research Batten’s Sebastian Tello Trillo and his co-authors answer the question are there regional disparities in prior authorization requirements for HIV pre-exposure prophylaxis? What does the coronavirus pandemic mean for your health insurance? An economist responds. News For the latest in Batten’s new Expert Chat Series, Batten professor Sebastian Tello-Trillo discussed how the coronavirus pandemic will impact health insurance coverage. Professor Spotlight: Sebastian Tello-Trillo News Professor Sebastian Tello-Trillo didn’t always want to be an economist. But, he did always want to find a way to address social problems.