White House must ensure access to cutting-edge prevention drugs
The Biden-Harris administration has a historic opportunity to help end HIV. New, cutting-edge drugs that prevent HIV are hitting the market, but insurance companies are trying to twist the rules to deny access to these remarkable therapies.
Pre-Exposure Prophylaxis (PrEP) drugs represent one of the most vital tools we have to combat HIV. These highly effective therapies can reduce the risk of contracting HIV by up to 99%. So far, the FDA has approved two once-daily PrEP pills, and in 2021, approved the first long-acting injectable version of PrEP.
Currently, just 36% of people who could benefit from PrEP are using it. Racial and ethnic groups face wide disparities in PrEP uptake. For example, Black individuals constitute 39% of new HIV diagnoses but only 14% of PrEP users.
A new federal directive, if properly enforced, could help close these gaps. In August 2023, a panel of prevention experts issued an updated recommendation to clinicians, recommending PrEP—including long-acting forms of the drugs—to people who want to prevent HIV acquisition. Under the Affordable Care Act, most newly issued private health plans must be covered without patient cost-sharing to comply with this recommendation beginning in September.
Yet many HIV experts and patient advocates have raised concerns that insurers could misinterpret the task force’s decision and keep barriers to PrEP in place.
One top concern is that insurance companies could decide to cover only one kind of PrEP, even though the task force’s recommendation isn’t drug-specific—it applies to all versions. Yet long-acting PrEP is a critical option for many patients, such as those who struggle to adhere to once-daily drug regimens.
The Biden-Harris administration, through the Centers for Medicare & Medicaid Services (CMS), has an opportunity to issue clear, detailed guidance that ensures health plans comply with the legal requirement to cover PrEP for all eligible patients at no cost.
CMS’s guidance should clarify that insurance companies must cover all FDA-approved PrEP versions, including daily pills and long-acting injectables.
Doctors—not insurance companies—should decide which drugs best suit patients’ needs.
Carl Schmid is executive director of the HIV+Hepatitis Policy Institute.
