PrEP Doctor Speaks Out: An Interview with Dr. James Wantuck
Dr. James Wantuck is the Chief Medical Officer and Founder of PlushCare. After spending years working in the medical field, Dr. Wantuck decided that there must be a better way to do medicine. He found the current medical system difficult and frustrating – both for himself and for his patients. Dr. Wantuck, along with his business partner Ryan McQuaid, decided to start PlushCare because he wanted to provide a more efficient, convenient, and high quality medical care option to his patients.
PrEP is an anti-HIV medication that prevents HIV infection in HIV-negative individuals. The CDC reports that as few as 1 in 3 doctors nationwide do not know about PrEP, and many providers won’t prescribe it to their patients.
Dr. Wantuck wants to help eliminate this barrier and sees telemedicine as the perfect way to do so. PlushCare is quickly becoming one of the largest virtual PrEP programs in the country. All of the PlushCare physicians are trained to educate patients on HIV prevention and prescribe the PrEP medication. They are highly knowledgeable about PrEP and are excited about the opportunity to help you make an educated decision on whether or not you should be taking PrEP.
The PlushCare virtual/online PrEP program is quickly becoming one of the largest in the nation – why are you placing such emphasis on this program at PlushCare? Why is it so important to you?
We started PlushCare to improve access to healthcare, and PrEP is one specific area where access was really a problem, whether it was because of the stigma around HIV or the lack of knowledge among physicians and patients. I’ve seen many patients over the years who have suffered the consequences of HIV and the stigma that comes along with being gay. I hope to help alleviate this burden and think that our PrEP program is definitely a step in a positive direction.
PrEP is a relatively new treatment that is not yet integrated into our national medical system, so it made sense to do this virtually. Doing the PrEP appointments online means that our patients will always have a highly knowledgeable doctor at their fingertips. It makes the end-to-end treatment that PrEP patients need very simple and easy.
How effective is PrEP really?
The scientific evidence is very strong – if people take their PrEP medication everyday and are consistent with it, it is 99% effective. The only reason it wouldn’t work is if you weren’t taking it.
Are there any alternatives to the Truvada pill?
Truvada is currently the only medication approved by the FDA for HIV prevention. Unfortunately there isn’t a generic form of the medication available at the moment. Other medications may work – and will likely be available in the future – but as of now they haven’t been tested properly and are not available to the public.
What are some of the benefits to using a telemedicine provider to get PrEP?
It’s convenient, obviously. We are specialized and have a lot of knowledge on PrEP. Our doctors make sure that you are getting the right treatment and our Care Coordinators make sure that your insurance is going to pay for it and that the lab work process is quick and easy. Everything can be done right from your phone – no travelling and no waiting room.
We know that PrEP is still inaccessible for much of the U.S. population. What do you think about the current status of PrEP in the U.S.?
In general, doctors and the medical system are very slow to adopt new treatments or drugs or knowledge – it takes about 17 years for a medical breakthrough to become a widespread treatment practice. Doctors are cautious and doing something new is potentially risky for their practice. PrEP is such an important advancement that we felt it was important to get it to as many people access to it as fast as possible.
I think from the outset people thought that PrEP would expand much faster than it did, but we’ve seen a certain degree of stigma around taking it. There has not been enough public education on the matter, and physicians are still not educated on it or comfortable with it, either. Often times the issue is also that physicians are not comfortable talking about sexuality with patient. Race and geographic location have both shown to be factors in whether a doctor is willing to discuss a patient’s sexuality with them.
What have been some of the biggest successes you’ve seen as you’ve begun to launch PlushCare’s nationwide PrEP program?
Our retention rate. The biggest problem with these programs is that people fall off of them because it takes a lot of effort to keep track. We’ve become very good at reminding people, keeping track and making sure that people stay up to date with our program. Our latest statistic is 90% of people who have an initial PrEP appointment have their second appointment 3 months later. Thats a huge feat for HIV prevention.
We have also diagnosed several HIV-positive cases in people who are looking to start PrEP. This really demonstrates that the population that we are targeting for PrEP – men who have sex with men – is at very high risk for contracting HIV. PrEP also applies to other groups like sex workers and IV drug users, both of which are at high risk for contracting HIV. We don’t have specific data on our patients who fall into those categories but we are open to treating anyone who needs the medicine.
What have some of the biggest challenges been with the PlushCare PrEP program?
People who change insurance and either no longer have access to our services or have more trouble getting the drug paid for. Without insurance, Truvada medication costs roughly $1300/month. With insurance it should be covered, but often insurance plans do not cover nearly enough to make the medication a reasonable financial undertaking. PlushCare has been addressing this issue by guiding patients through the insurance process and helping them obtain Gilead’s CoPay Assistance Program, which helps alleviate these costs.
The other problem is getting the word out. It’s not a topic that people necessarily want to be advertised to about, so the question has been about how we can promote PrEP without offending or stigmatizing anyone. One of the major successes in breaking down these barriers has been through word of mouth. The LGBTQ+ community is very open about this topic and has been willing to share with their friends.
PrEP is traditionally controversial and 1 out of 3 doctors don’t even know about PrEP. Have you had resistance from doctors?
We have been very fortunate to have physicians that are thrilled to be able to offer this to our patients and serve this population.
Are there any major roadblocks you foresee in normalizing and expanding PrEP to a nationwide drug?
Insurance is always a concern, especially with a medication as expensive as Truvada – every state has a unique medicaid program which makes it very challenging for us to serve everyone everywhere (not that we are not going to try, but it is logistically difficult).
Traditionally PrEP has been marketed to gay and bisexual men because they have some of the highest risk for contracting HIV. Do you still think this is the best strategy, or are there other groups who could benefit from PrEP?
The CDC recommends that PrEP can benefit gay/bisexual men who have an HIV-positive partner, multiple partners, a partner who has multiple partners, or a partner whose HIV status is unknown. PrEP can also benefit heterosexual people who have a partner that falls into any of the aforementioned categories. They also recommend that injection drug users are a good candidate for PrEP, as well as sex workers.
What are you most excited about moving forward with the PrEP program? What are your long-term goals for the program?
Long-term we are excited to play a big part in ending new HIV infections in America. Of course that is a lofty goal, but it is achievable and multiple cities/nonprofits have made that their goal. San Francisco, for example, has set a “Getting to Zero” goal for the city. We are certainly aligned with this mentality. It’s much more realistic to eliminate HIV infections using an online prevention service as opposed to going to each clinic, educating each doctor, etc. across the nation.
To enroll in PlushCare’s PrEP program, please visit prep.plushcare.com or call 888-798-0620 to book a PrEP doctor consultation.
For more information about PrEP, please visit: https://plushcare.com/blog/plushcare-prep-faq/ and https://plushcare.com/blog/plushcare-why-prep-telemedicine/.