Insurers

Biden-Harris administration requires insurers to cover long-acting PrEP to prevent HIV

Oct 21, 2024

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.

Biden-Harris administration sides with insurers & fails to take steps to lower patient costs for prescription drugs

Oct 4, 2024

“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.”

Medicare Beneficiaries Can Now Access PrEP Without Cost-Sharing

Sep 30, 2024

“We commend the Biden-Harris administration for increasing PrEP uptake using all the tools at its disposal. Patient cost-sharing has been a significant barrier for Medicare beneficiaries. With this new NCD, people on Medicare can join those with private insurance who can access PrEP without cost-sharing. Now we have to make sure these policies are properly implemented and enforced,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute.

Twice a Year HIV Prevention Drug May Soon Be Available

Sep 12, 2024

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.

63 HIV organizations urge Biden administration to require insurers to cover long-acting PrEP without cost-sharing

Jul 17, 2024

“Long-acting PrEP can be the answer to low PrEP uptake, particularly in the communities not using PrEP today. The Biden administration has an opportunity to ensure that people with private insurance can access PrEP now and into the future, free of any cost-sharing, with properly worded guidance to insurers,” commented Carl Schmid, Executive Director of the HIV+Hepatitis Policy Institute. “Poor PrEP uptake among various racial and ethnic groups is an example of failed healthcare decisions of the past. CMS can help correct these inequities by requiring insurers nationwide to cover all FDA-approved PrEP drugs, without burdensome prior authorizations, and begin the vigorous enforcement of ACA protections that has been lacking to date.”

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