Enhancing HIV Patient Outcomes Through Collaboration

As the new year begins, Highmark Wholecare would like to highlight recent advancements in Human immunodeficiency virus (HIV) prevention and treatment and promote collaborative strategies to improve patient outcomes.

Prevention

To help support prevention, Highmark Wholecare covers the medications and tests detailed in the paragraph below with no co-pay. Please encourage members to appeal any incorrect billing.

All adults should be assessed for Pre-Exposure Prophylaxis (PrEP) eligibility, particularly those with risky sexual behaviors (for example, inconsistent condom use, partners with unknown HIV status, history of STIs, etc.). PrEP options include oral Truvada, Descovy (excluding receptive vaginal sex risk), and injectable cabotegravir. While no PrEP medication is FDA-approved for persons who use injection drugs, CDC guidelines suggest that it may benefit those at risk. "On-demand" PrEP is also available for men who have sex with men. Post-exposure prophylaxis (PEP) with doxycycline can prevent gonorrhea, chlamydia, and syphilis. PrEP users need counseling on adherence and safe sex practices, along with regular testing.

The full article on the recommendations can be found at the USPSTF website and the JAMA website.

Treatment for Those Living with HIV

Only about half of Highmark Wholecare members with HIV take their medication daily. The following advancements are now available to patients living with HIV:

• Long-acting injectable antiretroviral therapy (LAI) for virologically suppressed patients
• Simplified regimens
• Individualized treatment plans

Even with these advancements, challenges with adherence issues, drug resistance, and co-morbidities remain. Providers can address these using shared decision-making, medication reminders, support groups, regular viral load monitoring, and integrated care.

Collaboration is Key

Together, we can improve HIV care through strong referral networks, case management, and shared decision-making. Additionally, resources like the CDC and HIV.gov help us all stay updated on care guidelines.

Highmark Wholecare offers prior authorization support, provider education such as the Mid Atlantic AIDS Education and Training Center, clinical guidelines, and dedicated clinical liaisons to help improve patient outcomes. Contact Highmark Wholecare Provider Services at 1-800-392-1147 for assistance.