PrEP must be completely covered by health insurance companies, say feds

Wed. July 21, 2021 11:09 AM by Gerald Farinas


photo credit // niaid

Truvada will be free to all insured persons

The federal government announced that all health insurers in the U.S. must completely cover the cost of HIV-prevention pre-exposure prophylaxis or PrEP. This means PrEP, mostly Truvada, will be free for all insured persons: no drug copay, no doctor visit copay, no lab test copay, no coinsurance fees or deductibles.

The move by the Centers for Medicare and Medicaid Services (CMS) comes at the heels of Gilead Sciences announcing that it will no longer reimburse clinics and patients for drugs that they make, Truvada and Descovy. Truvada costs $1,842 per month.

Descovy, a newer drug, is sold at an even higher price. A doctor will have to prove to an insurance company that it will be medically necessary for a patient to have it versus the cheaper Truvada.

CMS, U.S. Department of Labor, and U.S. Department of the Treasury told insurers that theu have 60 days to comply with the new rule.

The measure is part of an evolution of the Affordable Care Act, commonly called Obamacare. PrEP received an "A" rating by the U.S. Preventive Services Task Force. Guidance says that such services must be covered completely by health insurers. This includes regular HIV testing.