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Following a new provision established in January, the Biden administration issued guidelines ordering health insurance companies to provide PrEP coverage at no additional cost, meaning people wouldn’t have to pay co-pay or to contribute to their franchises.
The Departments of Labor, Treasury, and Health and Human Services jointly unveiled an announcement highlighting the Affordable Care Act requirement that preventive services recommended by the United States Preventive Services Task Force (USPSTF) are covered without cost sharing. In 2019, the working group gave PrEP an “A” rating, meaning that PrEP would then be considered a preventive service covered by the Affordable Care Act.
Notably, insurers will be required to cover office visits in addition to lab work and the drugs themselves. This could ease the burden on those who might have been discouraged from PrEP because of the costs associated with maintaining appointments and lab work.
Insurers will have 60 days to comply with the new guidelines, although some states have already maintained such policies. In New York, for example, Gov. Andrew Cuomo issued a similar regulation requiring insurers to cover PrEP and HIV tests without cost sharing.
The HIV + Hepatitis Policy Institute, which said it found that some health insurance plans did not cover needed HIV prevention services, welcomed the administration’s latest news.
“We are delighted that the federal government has released these long-awaited guidelines to insurers that will reduce barriers to PrEP and help prevent new HIV infections while advancing efforts to end HIV in the United States,” Carl Schmid, executive director of the HIV + Hepatitis Policy Institute, said in a written statement. “It appears that insurers have responded to our previous analysis. However, now we need to ensure that everyone fully complies with their legal requirements, including those set out in the new guidelines, and that federal and state regulators enforce them. “
The PrEP4All coalition, which works to improve access to PrEP, welcomed the move, but warned that “many of the people most vulnerable to HIV are uninsured and still face costs. huge when trying to get PrEP ”.
“We are facing a crisis among people who are often poor and uninsured who have fewer and fewer options for getting PrEP care,” Kenyon Farrow of PrEP4All said in a Twitter post. “The federal government needs to find ways for uninsured people, especially in non-Medicaid Expansion states, to access PrEP services. If we are serious about ending the HIV epidemic, we need to ensure equal access to PrEP in all communities, not just those who are insured.
A CDC report released earlier this year noted that between 2015 and 2019, an 8% drop in HIV infections nationwide was due in part to increased access to PrEP. However, the same report cited the barriers people of color face when it comes to PrEP. Sixty-three percent of whites eligible for PrEP received it in 2019, compared to just eight percent of blacks and 14% of Latinxes.
While PrEP has long been considered a daily HIV prevention pill, New York City health officials released guidelines in 2019 indicating that men who have sex with men (from other demographics were not included) may take a “PrEP on demand” approach while taking pills. when they plan to have sex.
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