Data to Care Rx: Using Real-time Prescription Claims Data to Support the HIV Care Continuum | CDC RFA PS17 1709

Opportunity Information: Apply for CDC RFA PS17 1709

Data to Care Rx: Using Real-time Prescription Claims Data to Support the HIV Care Continuum (CDC RFA PS17-1709) is a CDC cooperative agreement designed to strengthen HIV treatment engagement by adding a faster, more actionable data source to the traditional "Data to Care" (D2C) approach. The opportunity is rooted in a persistent gap across the U.S. HIV care continuum: out of roughly 1.2 million people living with HIV, only about 40 percent are engaged in HIV medical care and around 30 percent have achieved viral suppression. This matters both for individual health and for prevention because the bulk of new HIV transmissions are linked to people who are not fully retained in care. The grant focuses on improving how quickly programs can detect when someone is drifting away from treatment and then respond before that person becomes fully "out of care."

Traditional D2C relies heavily on HIV surveillance data reported to health departments, particularly CD4 and viral load lab results. While useful, those lab signals are inherently delayed because monitoring tests are typically performed every 3 to 6 months, and then must be reported and processed. As a result, the standard D2C model often confirms a lapse in care only after a gap has already occurred, limiting the ability to intervene early. The central idea of Data to Care Rx is to supplement or enhance surveillance-based methods with near real-time pharmacy prescription claims data, creating earlier warning signals of nonadherence and potential loss to care.

The program leverages the fact that antiretroviral therapy is commonly dispensed in 30-day supplies, making monthly refill patterns a practical proxy for adherence and continuity. Pharmacy refill data can reveal when a person stops picking up medication, which may indicate treatment interruptions, barriers to access, or broader disengagement from care. Importantly, the grant highlights why pharmacy benefit managers (PBMs) are especially valuable for this purpose. People can switch among pharmacies, and a single pharmacy chain may not see the full refill history if a patient moves to a different chain or an independent pharmacy. PBMs, however, adjudicate claims on behalf of insurers and can track prescription claims across pharmacies, providing a more complete, centralized view of refill behavior. Because PBMs manage pharmacy benefits for an estimated 85 percent of people with prescription coverage, this approach has the potential for broad reach.

The cooperative agreement aims to develop and implement an intervention model that uses real-time (or near real-time) PBM pharmacy claims data to identify people who fail to pick up prescribed ARVs and are therefore at elevated risk for poor retention in HIV care. The model is structured around progressive, time-based outreach and support steps. First, a "1st line" intervention is triggered when an individual does not pick up prescribed ARVs within 30 days. Second, a more intensive adherence and retention intervention is initiated at either the prescribing clinic or the dispensing pharmacy when the individual has not picked up ARVs within 60 days. Third, if nonpickup persists to 90 days, the health department takes a more active role in locating the person and relinking them to clinical care and/or pharmacy services. This stepped approach is meant to escalate support in a targeted way, matching the intensity of intervention to the duration of medication nonpickup and the implied risk of disengagement.

Expected outcomes center on measurable improvements along the HIV care continuum: increased retention in HIV medical care, successful relinkage of people who have fallen out of care, improved adherence to antiretroviral therapy, and higher rates of viral load suppression. The program also addresses a key practical reality: a sizeable share of people on ARVs are nonadherent (the opportunity cites roughly 30 percent), so earlier identification of refill gaps could meaningfully reduce treatment interruptions and potentially prevent downstream loss to care.

Fundamentally, the grant funds a full cycle of work that includes building the model, putting it into practice, and then assessing whether it works. Activities are grouped into three broad categories: (1) developing a model that uses pharmacy claims data to identify ARV nonpickup and to route individuals into progressive adherence interventions; (2) implementing the model in real-world settings with clinical, pharmacy, and public health partners; and (3) evaluating outcomes and disseminating findings so the approach can be replicated or scaled. The emphasis on evaluation and dissemination reflects the intent to produce a usable, evidence-informed blueprint for other jurisdictions and partners.

Administratively, this was a discretionary CDC funding opportunity issued by the Department of Health and Human Services, Centers for Disease Control and Prevention (NCHHSTP). The funding instrument is a cooperative agreement, which typically means CDC expects substantial involvement and collaboration with the awardee during project execution. The opportunity listed an award ceiling of $875,000 and anticipated a single award. Eligible applicants were broad and included various levels of government, tribes and tribal organizations, public and private universities, nonprofits (with or without 501(c)(3) status), and for-profit entities including small businesses, indicating CDC interest in partnerships that can connect public health agencies with health systems, pharmacies, PBMs, and data/technology implementers. The opportunity was posted April 6, 2017, with an original closing date of June 5, 2017.

• The Department of Health and Human Services, Centers for Disease Control - NCHHSTP in the health sector is offering a public funding opportunity titled "Data to Care Rx: Using Real-time Prescription Claims Data to Support the HIV Care Continuum" and is now available to receive applicants.
• Interested and eligible applicants and submit their applications by referencing the CFDA number(s): 93.941.
• This funding opportunity was created on Apr 06, 2017.
• Applicants must submit their applications by Jun 05, 2017 Electronically submitted applications must be submitted no later than 500 p.m., ET, on the listed application due date.. (Agency may still review applications by suitable applicants for the remaining/unused allocated funding in 2026.)
• Each selected applicant is eligible to receive up to $875,000.00 in funding.
• The number of recipients for this funding is limited to 1 candidate(s).
• Eligible applicants include: State governments, County governments, City or township governments, Special district governments, Independent school districts, Public and State controlled institutions of higher education, Native American tribal governments (Federally recognized), Public housing authorities/Indian housing authorities, Native American tribal organizations (other than Federally recognized tribal governments), Nonprofits having a 501(c)(3) status with the IRS, other than institutions of higher education, Nonprofits that do not have a 501(c)(3) status with the IRS, other than institutions of higher education, Private institutions of higher education, For profit organizations other than small businesses, Small businesses, Unrestricted (i.e., open to any type of entity above), subject to any clarification in text field entitled Additional Information on Eligibility.

Apply for CDC RFA PS17 1709

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