New Program Seeks to Examine Whether Expedited Partner Therapy (EPT) Prescriptions are Filled with Free Pharmacy Discount Cards
In 2016, there were close to 67,000 cases of chlamydia reported in New York City (NYC). Chlamydia is the most commonly reported sexually transmitted infection (STI) in the city and rates of infection continue to rise steadily. While most clinicians have the resources to examine, diagnose, and prescribe treatment for patients they diagnose with chlamydia, clinicians often lack the resources to notify and treat their patients’ sex partners. When sex partners are left untreated, the original patient is at increased risk for becoming re-infected, and each repeat infection increases the risk of adverse side effects, which include pelvic inflammatory disease, ectopic pregnancy, and infertility.
To help protect treated patients from becoming re-infected, New York State passed a law in 2009 which allows clinicians to practice expedited partner therapy (EPT), a partner treatment strategy that involves offering medication or prescription to patients with chlamydia, to deliver to their sex partners without an intervening medical evaluation.
“EPT grew out of the limitations of traditional sex partner management strategies—it’s better than telling patients to notify their partners about the need to seek treatment and less resource-intense than having health care providers or public health workers contact partners and have them come in for testing,” said Jennifer Slutsker, City Research Scientist for the Bureau of Sexually Transmitted Disease Control at NYC DOHMH.
Recent evaluations conducted by the DOHMH suggest that EPT is commonly practiced using prescriptions. Unfortunately, some data indicate that when clinicians give a treated patient a prescription to deliver to his/her sex partner, the prescriptions may not be filled.
To address this issue, the NYC Department of Health and Mental Hygiene, in collaboration with the Fund for Public Health in New York City (FPHNYC), is conducting a project to provide free pharmacy discount cards to determine the proportion of EPT prescriptions that are filled when cost is eliminated. This project is supported by funding from the National Association of County and City Health Officials (NACCHO) as part of a NAACHO cooperative agreement with the US Centers for Disease Control and Prevention to build local capacity for STI prevention and control and to advance the evidence-base for effective STI prevention practice.
“We recognize that the cost and extra effort required to fill an EPT prescription creates barriers to sex partners being treated with EPT,” said Slutsker. “We hope the free discount cards help us understand whether and how EPT prescriptions are filled.”
Over the last couple of months, Slutsker has been traveling to clinics throughout the city to explain the program and distribute one-time use pharmacy discount cards that can be redeemed at most US pharmacies for the recommended treatment for chlamydial infection (azithromycin, 1 gram). Providers will give the discount cards to their patients at the time they treat them for chlamydia infection, along with paper EPT prescription(s) for each recent sex partner. Subsequently, chlamydia patients or their sex partners will be able to present the discount card and prescription at the pharmacy to obtain EPT medication free of charge. The pharmacy discount cards also enable DOHMH to track whether EPT prescriptions are filled.
At the end of the pilot in June 2018, epidemiologists from NYC DOHMH are hoping to learn more about whether EPT prescriptions are filled. “The data will help us envision a path forward for EPT in New York City and State,” said Slutsker.