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App allows PrEP access via phones

by David-Elijah Nahmod

An app that allows people to get PrEP prescriptions via their cellphones may expand access to the HIV prevention drug.

PlushCare is an app that is available for iOS and Android phones. Recently, the app expanded to 31 states, including California. There are plans to role the app out into the remaining states soon.

Dr. James Wantuck, PlushCare's chief medical officer, and Ryan McQuaid, the company's CEO, spoke to the Bay Area Reporter about the services the company provides, and why the app is needed.

"In San Francisco, most doctors know about PrEP," said Wantuck. "Outside of the city, doctors may not know about the latest treatments - they could be biased against prescribing PrEP."

PlushCare is based in San Francisco and was founded in 2014. It's a privately held company that received $8 million in venture capital funding.

Wantuck noted that the Food and Drug Administration approved PrEP in 2012. "It usually takes 18 years for an approved treatment to become standard practice," he said.

PlushCare's app may be one more avenue by which gay men and others who are HIV-negative can start on PrEP, which is a component of the city's Getting to Zero initiative.

Getting to Zero aims to make San Francisco the first city to achieve the UNAIDS goals of eliminating new HIV infections, deaths due to HIV/AIDS, and stigma against people living with HIV. It relies on a three-prong strategy of expanded access to PrEP, rapid initiation of antiretroviral therapy, and retaining HIV-positive people in care.

As the B.A.R. reported last week, the San Francisco Department of Public Health's latest HIV epidemiology report, released in September, shows that new HIV infections fell to 223 in 2016, a new all-time low. The city outdoes the country as a whole when it comes to helping people get tested, start treatment as soon as possible after diagnosis, and stay on therapy to achieve viral suppression.

McQuaid explained how PlushCare works.

"Just download the app and put in your insurance information," he said. "Then you book an appointment with the doctor of your choice."

According to its website, an appointment with a PlushCare physician costs $99. If a patient has health insurance from a payer PlushCare accepts, it will charge a patient their copay or coinsurance.

The appointments are conducted via video chat as though they were a regular doctor visit. The doctor orders lab work and makes a determination if PrEP is right for the patient. Lab work is conducted by Quest and LabCorp, and can be done at lab offices.

"The doctor has to be licensed in the state where the patient lives. We follow CDC recommendations on how often people on PrEP get lab testing and follow-up visits," said McQuaid, referring to the Centers for Disease Control and Prevention.

So far PlushCare has over 50 doctors in its system, and not all the patients they see are PrEP patients.

"We started doing urgent care treatment for colds, flu, and pink eye," said McQuaid. "It's only in the last six months that we've expanded to PrEP. Eighty percent of urgent care can be done via telemedicine. We emphasize having the highest quality providers. We take what we do extremely seriously. Our doctors are from the top 50 ranked medical institutions - we have a pretty rigorous interview process."

"We are in market with most of the major insurance carriers," added Wantuck. "We are working to get even more so everyone can have access to the service."

McQuaid said that while there was an overall decline in new HIV infections from 2008-2014, there was a 35 percent increase in infections among those ages 25-34 for the same period.

"This shows the importance of informing people about PrEP," he said.

For more information, visit http://www.plushcare.com.

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