As the U.S. prepares to welcome a new presidential administration, leaders from business, public health, and community organizations gathered in Atlanta last week to reaffirm their dedication to ending the HIV epidemic and improving access to prevention and care.
“Because of years of research and scientific advancements, we now have the tools to prevent and treat HIV and keep people living healthy and long lives,” said Carl Schmid, executive director of HIV+Hepatitis Policy Institute. “Now is not the time to retreat on our commitment to protecting the health of our nation. President Trump initiated the Ending the HIV Epidemic initiative in his first term, which was sustained by President Biden and his administration. Now we look forward to that same commitment from President Trump as he and his new administration seek to make our country healthier, bolster prevention, and address chronic diseases.”
With low uptake of PrEP among the communities most impacted by HIV, this insurance coverage requirement with zero cost-sharing will help jumpstart the use of more effective forms of PrEP and lead to fewer HIV transmissions. We are grateful to the Biden-Harris administration for responding to our request to issue this guidance. Without it, we feel some insurers would continue to only cover daily oral PrEP, and not provide PrEP users with the choice they need. With up to a third of privately insured PrEP users still being charged cost-sharing, we must ensure that both federal and state regulators vigorously enforce PrEP coverage requirements.
“Every day these rules are delayed is another day that insurers and PBMs are pocketing billions of dollars meant for patients who are struggling to afford their drugs,” commented Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “Coming from an administration that prides itself on supporting patients and lowering their prescription drug costs, this is a huge disappointment. While they have gone on record that they will issue these rules, the clock is ticking and there isn’t much time left.”
The goal now must be to ensure that people who have a reason to be on PrEP are able to access this miracle drug. Thanks to the ACA, insurers must cover PrEP without cost-sharing as a preventive service. Insurers should not be given the choice to cover just daily oral PrEP, particularly given these remarkable results . The Biden-Harris administration should immediately make that clear. To date, they have yet to do that for the first long-acting PrEP drug that new plans now must cover.