Democrats introduce bill to remove insurance barriers for HIV prevention medicine

Truvada PrEP medication pills, which are blue, on a white table next to a bottle.
Photo: Shutterstock

Senate Democrats are trying to make it easier for communities at risk of HIV transmission to access pre-exposure prophylaxis, or PrEP. PrEP, when taken as prescribed, is 99% effective at stopping the transmission of HIV.

Sen. Adam Schiff (D-CA) and Sen. Tina Smith (D-MN) introduced the PrEP Access and Coverage Act of 2021 last week in the Senate, a bill that they argue will help overcome some of the barriers to getting PrEP.

Related: Biden administration orders insurance companies to cover all costs associated with PrEP

The bill would eliminate out-of-pocket costs for PrEP for people who use public and some private insurance plans, making it easier to afford the medication.

It would also ban the practice of prior authorization for PrEP. Prior authorization is where doctors and other health care providers are required to justify the decision to prescribe PrEP and get approval from the insurance company. It’s a way insurance companies cut costs, and in the case of PrEP it puts people at risk of getting HIV.

The bill would also tackle discrimination in health care against people on PrEP, banning private insurers from raising premiums on someone who takes the medication.

Last, the bill would give funds for education campaigns and state and local governments to expand access to PrEP.

“Preventative medications like PrEP and PEP are one of the easiest and most effective ways to protect individuals against HIV,” Schiff said in a statement. “But what isn’t always easy, especially for those at the highest risk of infection, is obtaining that medication.”

“Our health care system must provide access to these preventative treatments for every patient who needs them – regardless of their race, ethnicity, sexual orientation, gender identity, income level, or health care coverage. The PrEP Access and Coverage Act would help us close those gaps, so that no one has to suffer from a now-preventable disease.”

The bill could help address inequality in access to PrEP as well. A recent study published in the Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report in September found that Black and latino gay and bi men were less likely to take PrEP than white gay and bi men. 42% of white participants in the study had taken PrEP within the last year, while 30% of latino and 26% of Black participants had.

58% of white participants said that they had discussed PrEP with a clinician in the past year, whereas only 44% of latino and 43% of Black participants said they had. Looking just at the gay and bi men who talked to a clinician about PrEP, white men were still more likely to report getting a prescription and taking PrEP than latino and Black men.

The researchers found that lack of insurance wasn’t entirely responsible for the disparities.

Another study published in the International Journal of Environmental Research and Public Health this month found that while Black men in the South who have sex with men were disproportionately affected by HIV, they were more likely to face barriers in getting PrEP, like stigma, poverty, distrust of the medical system, misinformation about PrEP, and transportation issues.

“According to the recent CDC HIV Surveillance Report, the South accounts for more than half of all new HIV diagnoses in the U.S.,” the authors wrote at The Conversation. “Men who had sex with men comprised 69% of the new national HIV diagnoses, with the rate higher among Black gay men. Another CDC study shows that half of Black gay men in the U.S will be diagnosed with HIV in their lifetime.”

While PrEP was approved by the FDA in 2012 and the Affordable Care Act requires most insurance companies cover it, “the nationwide HIV infection rate among Black and Latino gay and bisexual men has remained the same for the past 10 years, according to the CDC,” they wrote.

“The PrEP Access and Coverage Act ensures that all people, regardless of what type of healthcare they receive, have access to PrEP without paying anything out of pocket,” said AIDS Institute Executive Director Michael Ruppal in a statement. “Since PrEP was approved by the FDA, uptake has skewed towards privileged groups with better insurance and the ability to pay for the medication and associated costs. This bill will help to create more equitable access to this life-saving medication by requiring nearly all public and private insurers cover the medication as well as the labs and doctors visits that are required to start and maintain a PrEP prescription.”

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