Under new federal guidance issued Monday, almost all insurance companies are now required to cover all out-of-pocket costs for the HIV prevention medication known as PrEP.
Issued by the Centers for Medicare and Medicaid Services alongside the Department of Labor and the Department of the Treasury, the guidance is in accordance with the U.S. Preventive Services Task Force’s 2019 action granting the medication an “A” rating — as it has been proven to be up to 99% effective. Under the Affordable Care Act (ACA), that grade means that insurers cannot charge for the service.
As NBC News first reported, the policy doesn’t just require companies to cover the drug’s cost, but the cost of associated clinic visits and lab fees as well, which can be substantial. Patients are required to get a blood test every three months to maintain their prescription, which can cost hundreds of dollars.
PrEP, which stands for pre-exposure prophylaxis, is currently approved by the Food and Drug Administration (FDA) and sold in two forms: Truvada, which was first cleared in 2012, and Descovy, approved in 2019. Both drugs are manufactured by pharmaceutical giant Gilead, which has come under fire for the drugs’ extremely high costs. Truvada’s list price currently sits at $1,842, and Descovy retails for $1,930.
While a generic form of Truvada manufactured by Teva pharmaceuticals is now available for the much more reasonable price of $30 per month, it only became available at the end of last year.
Jim Pickett, who is the senior director of prevention advocacy and gay men’s health at AIDS Foundation Chicago, told NBC News that the announcement made him “jump for joy,” He also stressed the importance of making sure that insurance companies and Medicaid authorities follow through, however.
Other LGBTQ+ advocates are similarly concerned. Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, said that it’s important that people are aware of the new requirements. “We also have to hold insurers accountable to ensure they are doing their job in complying with their legal obligations,” he told NBC News. “We need state insurance regulators to enforce the law and the new guidance.”
PrEP: The Story of a Sexual Revolution
Over the past eight years, the once-daily pill has ushered in a sexual, social, and political revolution among those most at risk of HIV. This is the story of PrEP’s rise, who’s been left behind, and the ongoing effort to make HIV/AIDS history.
PrEP’s usage has shot up among eligible users in recent years, jumping from 3% to 23% — or nearly 285,000 users — from 2015 to 2019, according to a May 2021 report from the Centers for Disease Control (CDC). But due to factors like the medication’s high cost, as well as systemic barriers to access and misinformation, these numbers include significant racial disparities. While 63% of eligible white people were prescribed PrEP in 2019, the CDC found that just 8% of eligible Black people and 14% of eligible Latinx people were taking the medication.
The report also noted significant disparities in rates of new HIV transmission: Black people, for instance, are diagnosed with HIV at rates eight times as high as white people.
But HIV prevention advocates are nevertheless hopeful that recent policy and science breakthroughs could end the epidemic for good. “This has the potential to wipe out many of the access obstacles we face with PrEP provision,” said Pickett. “I look forward to radical improvements in PrEP access, particularly for the communities who are most vulnerable to HIV.”
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