2-month injectable Cabotegravir approved for PrEP!

[fskn]

With the earlier approval of one-month injectable Cabotegravir for HIV treatment in the US, and very decisive research results in prevention studies, two-month injectable Cabotegravir for PrEP has just been approved by the FDA!

[think before following links] https://www.poz.com/article/apretude-approvedthe-first-longacting-injectable-prep-option

There will be insurance questions, because injectable medications are usually covered on a different basis than outpatient prescriptions. Given the long-acting nature of the injectable, there is an option for an oral lead-in (taking Cabotegravir in pill form first). There will also be a need for contingency planning, in case a patient misses an injection.

[bbpoznow]

hope they get that here in Canada . if approved in the US , will be just a matter of time before approved  here 

[fskn]

5 minutes ago, bbpoznow said:

hope they get that here in Canada . if approved in the US , will be just a matter of time before approved  here 

Federal (Health Canada) approval shouldn't pose particular problems, though it will take time, but how the provincial health plans respond could pose a problem.

A relevant example is medical (pill-based) abortion. Because the provincial health plans stubbornly refuse to cover most prescriptions, Canadian women continued to rely on surgical abortion long after the pill-based option was approved. The provinces have finally realized that surgery is more expensive than pills, and have started to provide coverage and expand access.

Access to Truvada (or generic equivalent)and Descovy for PrEP remains a problem for Canadians without employer-provided supplemental health insurance, again, because the provincial health plans don't cover most prescriptions.

Hopefully the potential for net savings from preventing HIV infections (the provincial plans do cover drugs for treating HIV and a few other other costly, chronic conditions) will tip the scales in favor of routine provincial coverage for pills, and someday also injectables, for PrEP.

[bbpoznow]

so far   the  government has been covering my prep , so they may cover the  injection to . will have to wait and see

[PG1961Canada]

15 hours ago, fskn said:

Hopefully the potential for net savings from preventing HIV infections (the provincial plans do cover drugs for treating HIV and a few other other costly, chronic conditions) will tip the scales in favor of routine provincial coverage for pills, and someday also injectables, for PrEP.

Excellent point!  I am fortunate that my employer based insurance came to that conclusion years ago and started to cover Truvada when it was still around $900 a month.  The patent expired in Canada and price dropped to about $90 a month.  My PrEP clinic recommended I start Descovy to reduce stress on kidneys and I approached my provider and they agreed.  The cost is back up to $900 a month (Descovy), but they agreed it is cheaper to prevent - than to treat.  It is a win-win for everyone.

I look forward to hearing more about this method of prevention.  Thank you for bringing it to our attention.  Cheers

[bicep]

I haven’t decided yet if the convenience of not needing to remember to take a pill every day is worth the hassle of going to a clinic every two months to drop my pants for an injection in my ass.  Currently, I only need to see a doctor twice a year for PrEP. That’s for HIV and kidney testing. I go to a free STD clinic every three months for all STD tests.

[fskn]

11 hours ago, bicep said:

I haven’t decided yet if the convenience of not needing to remember to take a pill every day is worth the hassle of going to a clinic every two months to drop my pants for an injection in my ass.  Currently, I only need to see a doctor twice a year for PrEP. That’s for HIV and kidney testing. I go to a free STD clinic every three months for all STD tests.

It will very much be an individual decision, for patients to make in consultation with their PrEP providers.

I haven't had a face-to-face PrEP appointment in years, though I do of course go to a lab for tests. Since I test monthly, and an injection clinic is in the same building, there would be no inconvenience.

At Kaiser San Francisco, my PrEP provider (first a Pharm.D., and now an N.P.) and I exchange secure messages online, my prescription is renewed electronically and I can have it dispensed by mail or at any Kaiser pharmacy, and I have standing lab orders, so I can test at whatever Kaiser facility is convenient. I'm required to complete HIV and STI tests every 3 months, but I can go as often as every 3 weeks, and my choice based on my level of sexual risk is to go monthly. (Standing orders for safety tests and a Hepatitis C test are for 6- and 12-month intervals, respectively.)

Kaiser SF has been piloting 1-month injectable Cabotegravir for treatment, so I've asked whether they are ready to offer 2-month injectable Cabotegravir for prevention. I say "piloting" because even though FDA approval had been granted, and the research results on which the approval were based left no doubts about safety or efficacy, injectables pose lots of implementation issues.

The same amazing person who piloted Truvada for PrEP at Kaiser SF almost a decade ago (long before the preventive care mandate eliminated implementation issues like rebate forms) has been working on these practical questions for injectables, so I'm optimistic that this option will soon be available to people who want it.

Edited December 22, 2021 by fskn
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