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HEALTH
Health Insurers Directed to Cover PrEP
Many people on PrEP will no longer need to pay co-pays, deductibles
Health insurers will be required to cover the costs of PrEP within 60 days.
BY MATT TRACY
Following up on a new provision
established in January,
the Biden administration
has issued guidance directing
health insurance companies to
provide PrEP coverage at no extra
cost, meaning people would not have
to pay co-pays or contribute toward
their deductibles.
The Departments of Labor, Treasury,
and Health and Human Services
jointly unveiled an announcement
pointing to the Affordable Care
Act’s requirement that preventative
services recommended by the United
States Preventative Services Task
Force (USPSTF) be covered without
cost-sharing. In 2019, the task
force labeled PrEP with an “A” rating,
meaning PrEP would then qualify as
a preventative service covered under
the Affordable Care Act.
Notably, insurers will be required to
cover offi ce visits in addition to the lab
work and medication itself. This could
ease the burden on those who may
have been deterred from PrEP due to
the costs associated with maintaining
appointments and lab work.
Insurers will have 60 days to get in
compliance with the new guidance,
though certain states have already
maintained such policies. In New
York, for example, Governor Andrew
Cuomo issued a similar regulation
requiring insurers to cover PrEP and
HIV screenings without cost-sharing.
The HIV+Hepatitis Policy Institute,
which claimed to have found certain
health insurance plans failing to
cover necessary HIV prevention services,
welcomed the latest news from
the administration.
“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,” Carl Schmid, the executive
director of the HIV+Hepatitis Policy
Institute, said in a written statement.
“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.”
The PrEP4All coalition, which
works to boost access to PrEP, praised
the move but cautioned that “many
of those most vulnerable to HIV don’t
have insurance and still face huge
costs when trying to get PrEP.”
WIKIMEDIA COMMONS/NIAID
“We’re facing a crisis among people
who are often poor and uninsured
who have decreasing options to get
PrEP care covered,” PrEP4All’s Kenyon
Farrow said in a Twitter post.
“The Federal government must fi nd
ways for people who are uninsured,
particularly in non-Medicaid Expansion
states, to access PrEP services.
If we’re serious about ending the HIV
epidemic, we have to ensure equal access
to PrEP in all communities, and
not only for the insured.”
A CDC report unveiled earlier this
year noted that between 2015 and
2019, an eight percent drop in HIV
infections nationwide was driven in
part by increased access to PrEP.
However, the same report cited the
barriers facing people of color when
it comes to PrEP. Sixty-three percent
of white people eligible for PrEP were
prescribed it in 2019 compared to
just eight percent of Black people and
14 percent of Latinx people.
While PrEP has long been viewed
as a daily HIV prevention pill, New
York City health offi cials rolled out
guidance in 2019 stating that men
who have sex with men (other demographics
were not included) can
take a “PrEP on Demand” approach
by taking pills around the time when
they are planning to have sex.
JULY 29 - AUGUST 11, 2 10 021 | GayCityNews.com
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