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PrEP to be covered in insurance plans

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Photo by Tony Webster
Photo by Tony Webster

The Treasury, Labor, and Health and Human Services Departments issued joint guidance in late July requiring insurance companies to cover the cost of pre-exposure prophylaxis (PrEP) prescriptions for insured recipients of the medication.

The decision was made in part to increase the coverage of certain preventive services under the Affordable Care Act and in alignment with the federal government's goal of ending the HIV epidemic by 2030. Companies have 60 days following the decision to cover the medication, which includes brand names Descovy and Truvada, depending on insurance plans.

"With respect to ending the epidemic, this particular policy decision absolutely helps to support us getting to that goal. PrEP is effective as a strategy... so let's do the work to decrease barriers to access," Dr. Stephaun Wallace, a staff scientist with Fred Hutch's Vaccine and Infectious Disease team and clinical assistant professor with the University of Washington, told the SGN.

With recent news of a potential HIV vaccine, the new policy might serve as a beacon of hope for increasing access to other preventive measures.

"[When] we do have an HIV vaccine, access is going to be a critical conversation. This particular decision lays the groundwork for precedent," said Dr. Wallace, who also serves as director of external relations for Fred Hutch's HIV Vaccine Trials Network. "It makes the conversation about how we can get other strategies covered — injectable treatment, injectable PrEP, vaccines, whatever else is coming down the pipe — that we can also get those things covered to ensure that people, regardless of insurance status, have access to these options."

Less than 10% of individuals who could benefit from PrEP are taking the medication, and forty thousand new cases are diagnosed in the US each year, according to Kaiser Health News. For Dr. Wallace, the increase of access to medications will only be successful when HIV stigma, and the intersection of stigma with oppressed groups, is also addressed.

"While getting people access to prevention methods is a critical component to ending the epidemic, we also need to ensure that we're also putting attention into addressing stigma and particular intersections of stigma: people who identify with the LGBTQ community, people who are living with HIV, people of color, immigrants, migrants, transgender communities, sex workers, people who use drugs," Dr. Wallace said.

"We can pump out all of the behavioral and biomedical interventions. But if we do not address the environmental factors that contribute to seroconversions, then we will be missing the mark."

The government's policy decision also excludes Americans without adequate insurance and those facing more difficulty getting access to PrEP. For example, the pharmaceutical company Gilead recently announced plans to change reimbursement agreements with nonprofits and HIV prevention clinics. This change leaves more uninsured or underinsured patients to foot the bill for their own access to PrEP, which can cost nearly $2,000 per month.