Biden administration says life-saving PrEP must be fully covered by health insurers
The Biden administration has made a massive move forward in the US HIV prevention effort by directing almost all health insurers to offer PrEP at no additional cost.
NBC News reported that most insurers will be required to cover the costs of two approved forms of the HIV-preventative medication PrEP – Truvada and Descovy.
It means that health insurance companies will not be able to charge PrEP users who are insured for their prescription, or for associated clinic visits and lab tests.
The Centers for Medicare and Medicaid Services, the Department of Labor and the Department of the Treasury sent the new guidance to health insurers Monday (19 July). Insurance companies have 60 days from 19 July to comply with the new mandate and provide coverage or risk falling foul of federal law.
Most health plans were already required to cover the cost of PrEP without charging consumers based on the previous recommendation of the US Preventive Services Task Force. In June 2019, the task force granted PrEP an “A” rating, meaning that under the Affordable Care Act – often known as Obamacare – most health plans are required to offer PrEP without cost to the insured patient.
But it wasn’t until Biden took office in January that the policy came into effect, and the new guidance further cracks down on insurers not complying with the federal mandate.
This has the ‘potential to wipe out’ obstacles activists face with PrEP provision
Jim Pickett, senior director of prevention advocacy and gay men’s health at AIDS Foundation Chicago, told NBC News that the new memo “literally made me jump for joy”.
“This has the potential to wipe out many of the access obstacles we face with PrEP provision,” Pickett said. “I look forward to radical improvements in PrEP access, particularly for the communities who are most vulnerable to HIV.”
Carl Schmid, the executive director of the HIV + Hepatitis Policy Institute, said in a statement that they are “pleased” with the new mandate and the Biden administration’s continued dedication to HIV prevention in the US.
“We are pleased that the federal government has issued this long-awaited guidance to insurers that will reduce barriers to PrEP and help prevent further HIV infections while advancing efforts to end HIV in the United States,” said Schmid.
But he warned that the work is not over as the government must ensure all insurers are “fully complying with their legal requirements, including those spelled out in the new guidance, and federal and state regulators enforce them”.
The new rule change, however, does not change the rules for uninsured people’s access to PrEP – representing a huge barrier still in the fight against HIV in the US.
According to NBC News, the list price for Descovy is currently $1,930 per month compared to Truvada’s price at $1,842. However, there is a generic form of Truvada which can cost as low as $30 per month, according to the outlet.
NBC News previously reported that Gilead Sciences provides PrEP for free to lower-income people who lack health insurance. However, the company does not cover associated clinic visits or lab tests.