ICYMI: HIV Prevention Drug PrEP to Be Covered by Most Insurance Plans

By Ayana Byrd Jun 18, 2019

PrEP is widely an effective way to prevent HIV infections, but its high cost and scarce availability means that only a fraction of those who are eligible to take the prescription drug actually do. But a new decision might change that.

Last week (June 11), the United States Preventative Services Task Force (USPSTF) issued a Grade A ranking to PrEP, which is an acronym for pre-exposure prophylaxis. In a statement, the organization said, “The task force found that clinicians should offer PrEP to persons at high risk for HIV.”

As Rewire.News reports, “The USPSTF is not part of the federal government—it’s an independent volunteer group comprising 16 physicians—but its guidelines carry considerable clout among public and private insurance programs.”

PrEP is a once-a-day pill that became available in 2012. It is considered to be 90 percent effective at preventing HIV infection via sex (and more than 70 percent effective at blocking it in drug injections). The Centers for Disease Control and Prevention (CDC) recommends the medication for 1.2 million people in the United States who are at increased risk of HIV. Yet PrEP, which is sold under the brand name Truvada, can cost up to $2,000 per month if not covered by health insurance. 

In March, The Washington Post published an investigative report that found that in most of the Deep South—where the concentration of new HIV diagnoses is highest—it is difficult to find the medication.

Not only is the problem regional, but it also has a racial component. As Colorlines previously reported:


Black men who have sex with men, are more likely to contract HIV than any other group in the U.S. In 2017, they accounted for 26 percent (10,070) of the 38,739 new HIV diagnoses and 37 percent of new diagnoses among all gay and bisexual men in the United States and dependent areas, according to the Centers for Disease Control and Prevention. Adding to the necessity of making PrEP readily available—and affordable—for this demographic, it is projected that half of all Black men who have sex with other men will be diagnosed with HIV in their lifetime.

Prompted by the USPSTF decision, the National Alliance of State and Territorial AIDS Directors (NASTAD) announced that beginning in January 2021, insurance plans will be required to cover the pill, and all necessary lab work and clinic visits, without deductibles or co-pays.

“Because high cost sharing has been a barrier to PrEP, the recommendation’s mandate that most private insurance plans cover PrEP without deductibles or co-pays means that far more individuals will have affordable access to PrEP through commercial insurance,” NASTAD Acting Executive Director Terrance Moore said in a statement. “Given the disparities in PrEP access, particularly among young, gay Black and Latino men and transgender women, we are hopeful that this recommendation will spur additional action and commitment to increasing access to PrEP for these populations.”

However, high numbers of HIV-positive individuals do not have health insurance. This, writes Rewire.News, means “doctors and HIV-prevention advocates caution that it may not make a difference for patients without insurance or with inadequate insurance, potentially deepening health disparities that already exist.”

For that reason, various health care advocates stress that the change in insurance policy is not a final solution. Sable Nelson of HIV advocacy organization NMAC told Rewire.News that the new ranking is “a step in the right direction, but it’s just one of the things that needs to happen. We need to get the conversation [about the drug’s availability] into the pockets of the communities where it’s most needed.”