In a move that is expected to prove transformative to the national HIV-prevention effort, the federal government has announced that almost all health insurers must cover the HIV prevention pill, known as PrEP, or pre-exposure prophylaxis, with no cost sharing.
That means that people on PrEP are not required to pay any copays or deductibles for the medication, labs, or office visits.
The Department of Labor sent guidance to health insurers Monday telling them that they have 60 days to comply with the mandate.
The rule says insurers must not charge copays, coinsurance, or deductible payments for the quarterly clinic visits and lab tests required to maintain a prescription for PrEP, or pre-exposure prophylaxis.
Truvada or Descovy are the two approved forms of PrEP, and a prescription can cost close to $2,000.
Insurers were already required to stop charging out-of-pocket fees for the medication by Jan. 1 at the latest.
HIV-prevention advocates said the guidance could be a huge leap forward in the effort to promote PrEP among people at risk of HIV.
“While we need state Medicaid authorities and departments of insurance to follow through on implementation, this memo from the federal government literally made me jump for joy,” Jim Pickett, senior director of prevention advocacy and gay men’s health at AIDS Foundation Chicago, told NBC News. “This has the potential to wipe out many of the access obstacles we face with PrEP provision. I look forward to radical improvements in PrEP access, particularly for the communities who are most vulnerable to HIV.”
The additional requirements will remove a substantial barrier to PrEP access for people with low income.
Also, the requirements are the result of the U.S. Preventive Services Task Force granting this form of HIV prevention an “A” rating in 2019.
Under the Affordable Care Act, such a rating for preventive health care services, including tests for various diseases such as HIV itself, means they must be covered by almost all insurers at no cost to the insured patient.
Truvada, which contains a pair of antiretroviral medications also used to treat HIV, was approved by the FDA for HIV prevention use in 2012. The medication reduces men’s risk of contracting the virus from sex with other men by more than 99 percent, and women’s risk of HIV by at least 90 percent, according to the Centers for Disease Control and Prevention.
More people started using PrEP in 2014 as media attention grew about the medication’s ability to turn the tide against HIV infections.
Descovy, which has been noted for improvements in bone density and kidney function tests compared to Truvada, was FDA approved in 2019.