Support for PrEP DC Act of 2025 (B26-0159)
Testimony by
Carl Schmid
Executive Director, HIV+Hepatitis Policy Institute
in support of
PrEP DC Act of 2025 (B26-0159)
Committee on Health, Council of the District of Columbia
October 30, 2025
Good morning. My name is Carl Schmid. I have been a resident of the District of Columbia for over 40 years and got my start in AIDS activism over 30 years ago here in DC. Now, I am the Executive Director of the HIV+Hepatitis Policy Institute, a national organization which promotes quality and affordable healthcare for people living with or at risk of HIV, hepatitis, and other serious and chronic health conditions.
Today we testify in support of the PrEP DC Act of 2025 (B26-0159) introduced by Councilmember Zachary Parker and co-introduced by eight other councilmembers. As the District continues to make progress in reducing the number of HIV infections, it must do everything possible in its power to ensure people who have a reason to protect themselves against HIV have access to all available prevention tools. That includes PrEP, which are incredible drugs that prevent HIV if people can access and afford them.
While the ACA requires people with private insurance to have access to no-cost preventive services, including PrEP, due to its favorable recommendation by the US Preventive Services Task Force (USPSTF), serious legal challenges to this requirement have recently made their way to the US Supreme Court. While we won, as part of that ruling the Court clarified that the HHS Secretary has considerable authority over the independent Task Force and its recommendations and in implementing its insurance coverage requirements. In fact, the current Secretary canceled a scheduled meeting of the Task Force, and its future is unknown. Therefore, in order to protect the coverage requirements, it is important for states to take steps on their own to protect their residents by passing legislation that mandates coverage.
While eighteen states have passed legislation prohibiting cost-sharing for PrEP or other preventive services, only six[i] provide protections for PrEP coverage without relying on the United States Preventive Services Task Force recommendation. We commend the authors of this bill for pursuing robust safeguards for DC. However, instead of relying on coverage of PrEP drugs that are included in CDC’s guidelines, since the work of the CDC is also under attack and the HIV division’s future is very much in doubt, we would recommend that the bill just require coverage of all FDA-approved PrEP drugs.
Another reason for the District and other states to pass this type of legislation is the rapid evolution of PrEP drugs. The USPSTF and federal guidelines cannot possibly issue an update every time a new PrEP drug is approved, nor should they. Initially PrEP was a daily oral drug and persistence was not high since people did not take their drug every day. In order to improve the effectiveness of PrEP, long-acting PrEP drugs have recently been approved. First, in 2022 there was an injectable given every two months and this summer an injectable given twice a year was approved. The twice-yearly drug was named Science magazine’s 2024 Breakthrough of the Year. Soon, we might have once every 4 months or once a year injectables and a monthly oral. If DC passes this law, insurers will have to cover each of them. Without the insurance requirement, payers look for ways to not cover the most recent advancements, leaving residents vulnerable to not being able to access or afford them. Prevention works best when the person has options and they can decide with their provider which one is best for them.
While insurers are supposed to be covering PrEP drugs without cost-sharing, many impose barriers to access such as unnecessary prior authorizations. While the federal government has issued guidance clarifying that this is not allowed, it is important for states to include this prohibition as part of their laws.
PrEP includes not just the medication, but several ancillary services recommended by clinical guidelines including HIV testing, laboratory testing, and medical visits. They also must be covered without cost-sharing, and we are pleased that this bill recognizes this.
Even copays under $10 can act as a barrier and lead to prescription abandonment—especially for preventive drugs. Despite federal requirements, studies have shown that a third of commercially insured PrEP users still face cost-sharing for PrEP medication and ancillary services. For years we have heard of PrEP users in the District being unlawfully charged cost-sharing or subjected to prior authorization requirements. Therefore, we urge the Council to ensure that the Department of Insurance makes sure insurers are in compliance and quickly respond to and resolve PrEP users’ complaints. When it comes to PrEP, people cannot risk delays in access.
We do have some minor suggested changes to the proposed bill and have included them as an attachment to this testimony.
The District should be applauded for the advancements it has made in reducing HIV over the years. In order to ensure that more people can access preventive services, such as PrEP, now and in the future, we strongly urge the Council to pass this bill. Thank you very much.
Attachment
Carl Schmid
cschmid@hivhep.org
(202) 462-3042
[i] Illinois, Maine, Minnesota, New Mexico, Oregon, and Rhode Island.