# Impact of Prescription Caps on Health Outcomes in People Infected with HIV

> **NIH NIH R01** · BROWN UNIVERSITY · 2021 · $100,025

## Abstract

PROJECT SUMMARY
Transgender and gender diverse (TGD) people, who have a gender identity that differs from their assigned birth
sex and who may use hormones to affirm their gender, are disproportionately affected by HIV. Antiretroviral
therapy (ART) greatly reduces HIV-related morbidity and mortality for those who are adherent and able to
achieve viral suppression. However, many TGD people with HIV face barriers to ART adherence, including
the inability to pay for medications. This study seeks to examine the health and economic impact of Medicaid
prescription caps for TGD people living with HIV–an NIH priority population. Prescription caps represent a cost-
containment strategy employed by some state Medicaid programs that limit the number of brand name drugs or
total number of prescriptions that may be filled in a given time window, typically per month. Though a few
outdated studies have used Medicaid data to evaluate the impact of prescription caps on the health of members
of the general population, until now, this has not been studied among TGD people. Relative to cisgender (non-
TGD) people, TGD people are not only at greater risk for HIV and other chronic conditions but also face economic
constraints and competing gender affirmation needs, including the necessary use of gender-affirming hormones
to alleviate psychological distress.35,39 In the face of prescription caps, people with HIV have to make tradeoffs
between which medications to use and we hypothesize that this tradeoff will lead to lower ART adherence, health
complications, and additional medical costs for both TGD and cisgender people with HIV. However, given the
documented health comorbidities, economic constraints, and gender affirmation needs that TGD people
disproportionately experience, we hypothesize that when faced with prescription caps, TGD people with HIV will
have lower levels of medication adherence and worst health outcomes than their cisgender counterparts. Health
services research involving Medicaid claims data has not historically accounted for TGD people as Medicaid
data does not include a reliable indicator of TGD status. In response to the NIH’s expressed interest to conduct
feasible, efficient, and rigorous research, we aim to apply novel algorithms developed by our team to identify
TGD and cisgender people with HIV in Medicaid data and study the impact of medication caps on the health of
these populations. Specifically, will build off the parent grant by using Medicaid data to explore the differential
impact of prescription caps on ART adherence for TGD and cisgender adults with HIV; evaluate whether
hormone use moderates the relationship between prescription caps and ART adherence among TGD people
alone; and estimate the potentially avoidable health and economic effects of medication caps and ART non-
adherence for TGD and cisgender people with HIV. We will engage TGD researchers and community members
throughout all stages of the study to ensure the cultural re...

## Key facts

- **NIH application ID:** 10334016
- **Project number:** 3R01MH122301-02S1
- **Recipient organization:** BROWN UNIVERSITY
- **Principal Investigator:** Omar Galarraga
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $100,025
- **Award type:** 3
- **Project period:** 2020-08-01 → 2022-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10334016

## Citation

> US National Institutes of Health, RePORTER application 10334016, Impact of Prescription Caps on Health Outcomes in People Infected with HIV (3R01MH122301-02S1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10334016. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*