Health insurers must cover all costs of PrEP, Biden administrative orders

Gilead Science’s Truvada for PrEP – Photo: Tony Webster

The Biden administration has ordered health insurers to cover all costs associated with pre-exposure prophylaxis, also known as PrEP.

A once-daily pill, PrEP uses antiretroviral therapy for HIV to prevent an HIV-negative person from contracting the virus. It reduces the risk of transmission during sex by about 99%, according to the CDC.

the Order of the Ministry of Labor means that insured persons accessing the drug – sold under the brand names Truvada and Descovy – will not face any copayments, deductibles or additional costs associated with PrEP.

This includes laboratory tests and quarterly clinic visits necessary to “monitor patients taking the drug to ensure its safe and continued use,” according to the guidelines.

Insurers have 60 days to classify PrEP as a zero-cost preventative drug. If they don’t comply, insurers will be violating the Biden administration’s interpretation of the Affordable Care Act, which requires health care plans to cover all costs for certain drugs and preventative services.

Although the guidelines require that PrEP and related services be free, they do not require insurers to cover Truvada or Descovy, with generic alternatives being allowed unless “a particular PrEP drug (generic or brand) is medically inappropriate, ”the guidance states.

The new guidelines from the Biden administration come just months after insurers were required to remove reimbursable fees for PrEP by January 1, 2021, NBC News reports.

By removing the financial burden of lab tests and clinic visits, the new guideline will “reduce barriers to PrEP and help prevent new 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 declaration.

“It appears that insurers have responded to our previous analysis,” Schmid continued. “However, now we need to make sure that everyone fully complies with their legal requirements, including those set out in the new guidelines, and that federal and state regulators enforce them.”

Jim Pickett, senior director of gay men’s health and prevention advocacy at the AIDS Foundation Chicago, told NBC News that posting the advice had made him “jump for joy.”

“This has the potential to remove many of the access barriers we face with providing PrEP,” he said. “I look forward to dramatic improvements in access to PrEP, especially for communities most vulnerable to HIV. “

While once-a-day PrEP has been shown to be very effective in reducing the risk of HIV transmission, new forms are being tested by drug companies that could reduce the pill dose to once a month, or one injection once. every two months.

Merck recently announced that its monthly PrEP pill was found to be “extremely potent” in phase two trials and said it was “probably a little more forgiving” than daily PrEP because of its long-lasting nature and ease. monthly requirement.

Last year, GlaxoSmithKline announced that its injectable PrEP treatment, given every two months, was more effective than Truvada in reducing the risk of HIV transmission.

GSK said its injections were 69% more than once-daily PrEP, already reducing the risk of transmission by around 99%, with results so promising that clinical trials were stopped early and those who did had received Truvada offered bi-weekly injections instead.

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