Published: August 2026
Despite more than a decade of availability and overwhelming evidence supporting its effectiveness, PrEP remains one of the most underutilized tools in HIV prevention. In 2022, only 36% of the estimated 1.2 million Americans who could benefit from PrEP were prescribed it, leaving a significant gap between those who may benefit from HIV prevention and those who actually receive it.1
For hospital and pharmacy leaders, the question is no longer about PrEP’s efficacy, it is how to ensure more patients can learn about and access it.
That question is at the heart of our clinical team’s latest pilot program, which explores how specialty pharmacies can identify opportunities for HIV prevention among patients receiving treatment for various conditions:
Historically, discussions about PrEP have been associated with infectious disease, primary care, or sexual health clinics. One of the less discussed barriers to PrEP adoption is that many healthcare providers do not consistently screen for PrEP eligibility or are uncertain about which patients should be offered PrEP.
Research has shown that provider education gaps, workflow limitations, and lack of familiarity with PrEP prescribing continue to contribute to underutilization of HIV prevention services.
In one study, providers were more likely to discuss PrEP when patients brought it up rather than to initiate the conversation themselves.2 This inconsistency contributes to ongoing disparities in PrEP access, especially for underserved communities and regions with limited access to infectious disease specialists or primary care providers.
Although utilization has increased overall, significant gaps remain among Black Americans, Hispanic/Latino populations, women, and individuals living in the southern United States. Many patients who could benefit from PrEP are never offered the opportunity to discuss it, not because they are ineligible, but because the conversation never occurs.
Recognizing these challenges, the CDC now recommends informing all sexually active adult and adolescent patients about PrEP and supports prescribing PrEP to anyone who requests it, even if they do not disclose traditional HIV risk factors.3 This guideline reflects a shift away from relying solely on provider assumptions or narrow risk-based screening approaches.
Expanding PrEP screening beyond traditional settings may create new opportunities to identify unmet needs and support more comprehensive patient care.
Specialty pharmacy represents an ideal pathway to do so. Such teams maintain trusted, long-term relationships with patients across a wide range of disease states. Throughout treatment, patients prescribed a specialty medication often interact with their pharmacy more frequently than other members of the healthcare team.
This relationship-building aspect is one of the most valuable components of pharmacist-led screening. Although patients may not be interested in PrEP or feel comfortable discussing HIV prevention today, a thoughtful and respectful conversation can establish trust and leave the door open for future engagement.
Therefore, pharmacy-led PrEP screening can help make HIV prevention conversations more routine, consistent, and equitable.
Many PrEP screening initiatives rely on lengthy risk assessments designed to classify patients according to risk. While valuable in some settings, these approaches can create administrative burden, reduce patient engagement, and limit opportunities for meaningful interaction.
We intentionally designed our pilot with a different philosophy that takes a unique two-pronged approach.
1. Screening should start a conversation, not end one
Rather than functioning as a diagnostic tool, our PrEP Risk Survey serves as a conversation starter. It uses a small number of focused questions to help pharmacists identify opportunities for education, counseling, and prevention discussions. The goal is not to assign a label but to create a comfortable way for patients to learn about HIV prevention and ask questions in a trusted setting.
Equally important, our pilot recognizes that readiness changes over time. The survey itself is not the intervention—instead, it represents the beginning of a conversation.
2. Screening should go beyond the traditional risk factors
One of the most exciting aspects of this pilot is the inclusion of patients receiving treatment for RA, Ps, and PsA. Although these conditions do not inherently increase HIV risk, their inclusion broadens our screening approach in line with the CDC’s new guideline.
It also helps prevent specialty pharmacies from unintentionally limiting access to patients who fit traditional assumptions about HIV risk. By incorporating both infectious disease and autoimmune populations, the pilot evaluates if preventive care conversations can be successfully integrated into specialty pharmacy workflows regardless of diagnosis.
In other words, this pilot explores what happens when HIV prevention becomes part of routine specialty pharmacy care rather than a targeted intervention reserved for select populations.
Specialty pharmacies have an opportunity to expand their role in population health initiatives while strengthening patient engagement and continuity of care. This pilot shows pharmacies can contribute to HIV prevention, so the question becomes how they can effectively do so at scale.
Identifying risk factors, documenting interventions, measuring outcomes, and demonstrating clinical impact all become increasingly important as specialty pharmacy’s role continues to evolve beyond dispensing—and technology can help.
The TherigySTM® platform provides a framework for integrating patient-reported assessments, documenting clinical interventions, supporting provider collaboration, and generating meaningful outcomes data without disrupting existing specialty pharmacy workflows.
Interested in learning more about the PrEP screening pilot?
Contact us here to explore how your organization can participate and help shape the future of pharmacist-led preventive care.
References:
1Kessler R. PrEP usage in U.S. hits historic highs, but disparities persist. amfAR. October 27, 2023. Accessed August 6, 2026. https://www.amfar.org/news/prep-usage-in-u-s-hits-historic-highs-but-disparities-persist/
2Sell J, Chen R, Huber C, Parascando J, Nunez J. Primary care provider HIV PrEP knowledge, attitudes, and prescribing habits: a cross-sectional survey of late adopters in rural and suburban practice. J Prim Care Community Health. 2023;14:21501319221147254. doi:10.1177/21501319221147254
3US Centers for Disease Control & Prevention. Clinical guidance for PrEP. US Dept of Health & Human Services. Updated April 30, 2026. Accessed August 6, 2026. https://www.cdc.gov/hivnexus/hcp/prep/index.html