NAIC consumer reps letter to MS Comm. Chaney on preventive services
Mississippi Insurance Department
1001 Woolfolk State Office Building
501 North West Street
Jackson MS 39205
Dear Commissioner Chaney:
The undersigned Consumer Representatives to the National Association of Insurance Commissioners (NAIC) write to express our deep concern regarding your recent public statements indicating that you do not intend to enforce the Affordable Care Act’s preventive services requirements with respect to coverage of pre-exposure prophylaxis (PrEP) for HIV prevention.
Under federal law, which was recently upheld by the U.S. Supreme Court in Kennedy v. Braidwood Management, Inc., insurers must cover without cost sharing evidence-based preventive services that receive a grade “A” and “B” from the U.S. Preventive Services Task Force (USPSTF). Also, under federal law, it is the responsibility of state regulators to ensure that insurers are in compliance, and that health coverage is administered fairly and consistently.
The USPSTF undergoes a rigorous process of evaluation prior to assigning a recommendation to a particular service or medication. Personal views regarding an individual’s lifestyle should not determine whether consumers have access to any type of service or medication that has been independently evaluated and recommended by nationally recognized medical experts. The decision to not enforce coverage protections for PrEP opens the door for regulators not to enforce cancer screenings because some patients may have smoked, coverage of cholesterol-lowering medications because some patients may not have a healthy diet, or the denial of preventive care because some patients are deemed too disabled to gain any benefit from such care and aren’t worth the trouble. This kind of picking and choosing is not only against federal law but fails to protect the rights of all consumers in your state.
Additionally, we are deeply troubled by comments suggesting that PrEP is used to support “alternative lifestyles” or to “promote promiscuity.” These statements are inconsistent with the medical evidence regarding PrEP and risk stigmatizing the many individuals who rely on this preventive medication to protect their health and the health of their families.
PrEP is one of the most effective preventive interventions developed in modern medicine. When taken as prescribed, it reduces the risk of acquiring HIV through sexual contact by approximately 99 percent.1 Its use is recommended by the USPSTF for individuals at increased risk of HIV infection because preventing HIV transmission is a critical public health objective.
Your comments also reflect fundamental misconceptions about PrEP and when and how it is used. PrEP is not used by a single population or for a single purpose. It is recommended based on established clinical guidelines for people from every walk of life, including healthcare workers, women, survivors of intimate partner violence, those trying to safely conceive while minimizing the risk of HIV transmission, and people in relationships where one partner is living with HIV.
In addition to public health and individual health benefits, there is also a compelling economic rationale for ensuring access to PrEP. Although providing preventive medication represents an upfront investment, preventing HIV infection avoids the far greater costs associated with lifelong treatment, monitoring, and medical complications.2 A person may require PrEP only during a period of elevated risk. By contrast, HIV infection requires lifelong antiretroviral therapy and ongoing medical care.
Preventive care improves health outcomes, reduces avoidable illness, and promotes efficient use of healthcare resources. That is why federal law requires coverage of evidence-based preventive interventions without cost sharing.
We respectfully urge you to reconsider both your stated enforcement position, and the public characterizations of PrEP and the individuals who use it. The people of Mississippi deserve to know that their insurance regulator will administer the law impartially and will support access to medically appropriate preventive care without stigma or discrimination.
We welcome the opportunity to discuss these issues further and to work collaboratively toward policies that protect the health of all Mississippi consumers. If you have any further questions, please contact Carl Schmid at (202) 365-7725 or cschmid@hivhep.org.
Sincerely,
Theresa Alban
Ben Anderson
Kellan Baker
Chuck Bell
Bonnie Burns
Jalisa Clark
Laura Colbert
Lucy Culp
Deborah Darcy
Shamus Durac
Joe Feldman
Lauren Finke
Adam Fox
Liz Hagen
Stephanie Hengst
Claire Heyison
Anna Schwamlein Howard
Anna Hyde
Amy Killelea
Lindsey Murtagh
Carl Schmid
Jennifer Snow
Deborah Steinberg
Wayne Turner
Milo Vieland
Silvia Yee
cc: NAIC Officers
1 Cohen MS, Gamble T, McCauley M. Prevention of HIV Transmission and the HPTN 052 Study. Annu Rev Med. 2020 Jan 27;71:347-360. doi: 10.1146/annurev-med-110918-034551. Epub 2019 Oct 25. PMID: 31652410.
2 Adaora A Adimora, Implementing National HIV/AIDS Strategy 2015 Treatment Targets Is Cost-effective and Would Save Lives: What Other Evidence Do We Need?, The Journal of Infectious Diseases, Volume 216, Issue 7, 1 October 2017, Pages 787–789, https://doi.org/10.1093/infdis/jix351; Borre ED, Hyle EP, Paltiel AD, Neilan AM, Sax PE, Freedberg KA, Weinstein MC, Walensky RP. The Clinical and Economic Impact of Attaining National HIV/AIDS Strategy Treatment Targets in the United States. J Infect Dis. 2017 Oct 17;216(7).