U.S. Insurance Companies Must Now Cover PrEP With No Cost-Sharing

In a massive move, the Biden Administration has released a new guidance that directs most health insurance companies to offer pre-exposure prophylaxis to beneficiaries at no cost. 

Pre-exposure prophylaxis, or PrEP, is a medicine taken to prevent at-risk communities from contracting HIV.

According to the guidance, released Monday by the Department of Labor, the Affordable Care Act requires health plans and market plans to offer preventative drugs that get a recommendation from the U.S. Preventative Services Task Force without cost-sharing. This means that beneficiaries will not be charged co-pays or deductibles for medicine, labs, or office visits. PrEP became a part of this in January but some insurers did not update their processes. Now the federal government has given insurers 60 days to provide coverage.

“We are pleased that the federal government has issued this long-awaited guidance to insurers that will reduce barriers to PrEP and help prevent further HIV infections while advancing efforts to end HIV in the United States,” Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, said in a statement Monday.

States like New York, California, and Colorado had previously taken action to ensure the medication was covered by insurers without cost-sharing.

“While progress is being made, it is obvious that insurers and regulators must do more to ensure people with private insurance can obtain PrEP without cost-sharing," Schmid said. "Additionally, transparency in how insurers display coverage of preventive medications such as PrEP needs further attention. We look forward to conducting additional plan reviews and holding all parties accountable for providing clear, transparent information to make it as easy as possible for people with insurance who need PrEP to access it.” 

Cost has long been seen as an obstacle to access for various communities.