Insurers were already required to stop charging fees for the medication at the start of the new year. However, the HIV+Hepatitis Policy Institute began hosting "spot checks" over the past few months, revealing many insurers were not in compliance and still charging policy holders. This updated legislation requires insurance companies to comply with new guidance 60 days from July 19, 2021, ensuring coverage for all policy holders, or face legal recourse.
“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 Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, per a press release. “It seems that insurers responded to our earlier analysis. However, now we must ensure all are fully complying with their legal requirements, including those spelled out in the new guidance, and federal and state regulators enforce them.”
When taken correctly by HIV-negative individuals, PrEP reduces the risk of contracting HIV from sex by 99 percent, according to the CDC. Currently available as a pill under the brand names Truvada and Descovy, PrEP is not a cure for HIV and it does not prevent transmission of any other STIs or STDs. (Research is ongoing for a PrEP injectable and an arm implant.) Nearly 1.2 million Americans live with HIV, with about 13 percent of those individuals unaware of their positive status.
“While progress is being made, it is obvious that insurers and regulators must do more to ensure people with private insurance can obtain PrEP without cost-sharing. Additionally, transparency in how insurers display coverage of preventive medications such as PrEP needs further attention," said Schmid in the same statement.
The Biden administration's mandate is welcome news in the continued fight against HIV/AIDS, but it doesn't change any access to the drug for the uninsured, leaving millions of Americans still vulnerable. "We look forward to conducting additional plan reviews and holding all parties accountable for providing clear, transparent information to make it as easy as possible for people with insurance who need PrEP to access it," Schmid said.
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