Biden Administration Revises PrEP Guidelines — Insurers To Pay All Costs

Tuesday July 27, 2021

Truvada  (Source:Associated Press)

The Biden administration "has announced that almost all health insurers must cover the HIV prevention pill, known as PrEP, or pre-exposure prophylaxis, with no cost sharing — including for the drug itself and, crucially, for clinic visits and lab tests," NBC News recently announced in a major change to policy.

"This means the entire experience of maintaining a prescription to Truvada or Descovy, the two approved forms of PrEP, should now be totally free for almost all insured individuals," NBC News added. "A prescribing physician, however, must persuade an insurer that Descovy in particular is medically necessary for any specific patient to qualify for zero cost sharing for that drug's use as HIV prevention."

On Monday, a directive sent to health insurers by the Centers for Medicare & Medicaid Services, the Department of Labor, and the Department of the Treasury indicated that insurers have 60 days to comply with the mandate. "The rule says insurers must not charge copays, coinsurance or deductible payments for the quarterly clinic visits and lab tests required to maintain a PrEP prescription," NBC News detailed.

"While we need state Medicaid authorities and departments of insurance to follow through on implementation, this memo from the federal government literally made me jump for joy," said Jim Pickett, the senior director of prevention advocacy and gay men's health at AIDS Foundation Chicago. "This has the potential to wipe out many of the access obstacles we face with PrEP provision. I look forward to radical improvements in PrEP access, particularly for the communities who are most vulnerable to HIV."

"However, Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, pointed out that many insurers are still not complying with the rule indicating they cannot charge consumers for their Truvada or Descovy prescriptions," NBC News added.

Gilead Sciences manufactures both drugs. "But PrEP is expensive. Truvada has an average retail price of nearly $2,000 per month without insurance, according to GoodRx. Descovy is similarly pricey, with an average retail price of around $2,300 for a 30-day supply," SELF Magazine reported. "There are various assistance programs that make PrEP available at a lower or no cost, the CDC says, but not everyone qualifies for these programs, which don't always cover the lab costs."