Congressional bills introduced to expand access to PrEP

Establishes Wider Insurance Coverage & National PrEP Program

Washington DC…In an effort to improve the uptake of PrEP to prevent HIV, Sen. Tina Smith (D-MN) and Rep. Adam Schiff (D-CA) have taken the lead again by reintroducing the “PrEP Access and Coverage Act of 2023,” (S.2188, HR 4392). The updated bills, originally introduced by then-Senator Kamala Harris, expand zero-cost sharing coverage of PrEP by private and public payers and set up a national grant program to provide PrEP to those who are uninsured.

While improving PrEP uptake is one of the central pillars to ending HIV under both President Trump and Biden, only 30 percent of people who could benefit from PrEP use it. However, there are wide disparities. While 78 percent of Whites who are eligible are using PrEP, for Blacks it is only 11 percent, Latinos 21 percent, and women 12 percent.

“We thank the leadership of Sen. Smith, Rep. Schiff, and their 53 colleagues in re-introducing the PrEP Access and Coverage Act,” commented Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “Passage of these bills will greatly expand access to PrEP for people who have health coverage across all payers and create a national PrEP program that includes community and provider outreach as well as PrEP drugs and associated services for the uninsured. We must address head on the wide disparities in PrEP use and these bills do that.”  

As in previous versions of the bills, the PrEP Access and Coverage Act would:

• Ensure comprehensive health insurance coverage of HIV prevention medications by eliminating out-of-pocket costs for the medication and associated costs, including lab fees, for individuals who are enrolled in federally regulated private and public health insurance plans (including Medicaid, Medicare, CHIP, and TRICARE).
• Prohibit prior authorization requirements for HIV prevention medication under private and public health insurance plans.
• Prohibit denying coverage or increasing premiums for disability insurance, long-term care insurance, or life insurance policies based on a person taking medication for HIV prevention.
• Direct the HHS Secretary to establish public health education campaigns to increase utilization of PEP and PrEP among individuals at risk of contracting HIV.
• Establish a grant program for states, territories, tribes, and health care facilities, such as Federally Qualified Health Centers and family planning centers, to expand access to PrEP and PEP for uninsured individuals and underserved communities.

Additionally, recognizing that some current PrEP users are being wrongfully charged cost-sharing by private insurers, the revised bills have a new section focused on compliance and enforcement.   

To address the need for a national PrEP program, President Biden included a ten-year $9.7 billion mandatory spending proposal in his current budget. 

Last year, the HIV+Hepatitis Policy Institute released a report modeling the resources needed to fund a national PrEP program.  Similar to the program outlined in the PrEP Access and Coverage Act, this model leverages existing successful programming being conducted by state and local jurisdictions, community health centers, CDC STD grantees, and the private sector, and calculates the amount of new support that would be needed to ensure at least 50 percent PrEP coverage in all communities. Our calculations show that $6.18 billion would be needed over ten years to meet the PrEP goals in the National HIV/AIDS Strategy and decrease the number of HIV diagnoses by 75 percent.

“We look forward to additional members of Congress lending their support to these bills and ask for their co-sponsorship.  We also hope that the committees of jurisdiction will soon consider the bills,” added Schmid. “At the same time, it is important that Congress continue to fund—and certainly, not cut—the modest existing PrEP initiatives through HRSA’s community health centers and the CDC’s HIV prevention programs. Without the necessary resources, we risk losing ground in the fight to end HIV,” Schmid concluded.

To read Sen. Smith’s press release click here.

To read Rep. Schiff’s press release, which includes the full list of House co-sponsors, click here.

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The HIV+Hepatitis Policy Institute is a national, non-profit organization whose mission is to promote quality and affordable healthcare for people living with or at risk of HIV, hepatitis, and other serious and chronic health conditions.