Taking PrEP — Pre Exposure Prophylaxis — drugs daily to prevent HIV is a bit pricey for most people and not covered by private insurance policies. Most insurers demand out-of-pocket payments for the HIV prevention drugs, making it hard for individuals to get the care they need.
However, this is changing with the introduction of new rules stating that insurance companies should include PrEP in their coverage. The HIV prevention drugs in this category include Truvada, Descovy, and the newly released generic version of Truvada.
The preceding medications received A recommendation from the U.S. Preventive Services Task Force. Under the Affordable Care Act, preventive services that get A or B ratings from the task force or a group of medical experts in prevention and primary care must be covered by private health plans.
The Act prohibits insurers from making the insured share the costs through copayments and deductibles. The task force recommends PrEP for people with a high risk of getting infected, including those in the LGBTQ+ community and injection drug users.
According to Michael Crews, a policy director for an LGBTQ+ community named One Colorado, cost-sharing has always been a problem. He added that it’s not just about getting on PrEP and taking a pill, but about the lab and clinical services.
In California, officials tried to address the problem by including guarantees that HIV prevention drugs and care provided along with the medications should be without cost-sharing for patients. The state banned healthcare providers from seeking approval from insurance companies to administer the pills.
The state also restricted using some of the PrEP medications if there’s the availability of cheaper ones. California went a step further by covering ancillary services with no cost-sharing, but it applies to state-regulated policies. However, with the new rule, things will be different.
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