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HIV Drug PrEP: Finally Free Under Most Insurance Plans

The U.S. federal government recently announced that almost all health insurers must cover the HIV prevention pill preexposure prophylaxis, also known as PrEP, with no cost-sharing to patients for the drug itself or, crucially, for clinic visits and lab visits.

The move is being hailed by HIV prevention advocates as transformative to the national HIV prevention effort.

“PrEP is an amazing prevention tool against HIV, but there’s been a number of barriers to accessing it, and one of the barriers has been the cost of the drug and associated lab services, periodic testing, and office visits,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, a nonprofit organization dedicated to promoting quality and affordable care to individuals living with or at risk of HIV, hepatitis, and other chronic health conditions.

“Having these costs wiped away will be tremendously beneficial in the prevention of HIV in the United States,” he continued

Who should take PrEP?

PrEP is a daily pill that reduces the risk of contracting HIV from sex by 99 percent when taken as prescribed, according to the Centers for Disease Control and Prevention (CDC)

It reduces the risk of contracting HIV through injection drug use by at least 74%.

A doctor may prescribe PrEP to a patient for a variety of reasons, said Dr. Antonio Urbina, professor of medicine at the Icahn School of Medicine at Mount Sinai and medical director for the Clinical Education Initiative of the New York State Department of Health AIDS Institute.

The medication is indicated for individuals who have a sexual partner with HIV or who engage in sex without a barrier method with a person who may be at risk of having HIV.

“Anyone diagnosed with a sexually transmitted infection may also have an indication to start on preexposure prophylaxis,” Urbina said.

PrEP is also recommended for people using injectable drugs who share equipment like needles and syringes.

Yet, despite its effectiveness at reducing the risk of HIV, PrEP is not reaching many Americans who can benefit from it. A 2018 analysis from the CDC found that about 1.1 million adults in the United States are at risk for HIV and should be offered PrEP, but only 78,360 PrEP prescriptions were filled in commercial pharmacies the year the study took place.

“Where [PrEP use] has scaled up most is in white gay men,” Urbina said. “But there’s a big gap.” While the majority of new HIV infections are in gay men, they are more in brown and Black gay men of color.”

“Similarly, in cisgender women, the majority of new infections are in Black and brown women,” he continued. “There’s also the transgender community, and uptake in all of these communities has been disproportionately lower than in white gay [cisgender] men.

Cost is a major barrier to access

While there are a number of barriers at play when it comes to addressing the gaps in who receives PrEP — from lack of awareness about the drug to stigma — cost plays a major role.

The average cost of a month’s supply of Truvada or Descovy is around $2,000. A generic version of Truvada is also available for as low as about $40 per month.

But it’s the cost of associated services required to maintain a PrEP prescription that can hit certain insured patients hardest

“PrEP is not a drug where you go to your doctor and get a prescription for a month with 11 refills,” Urbina explained. “Patients have to be seen every 3 to 4 months.”

This is why the government’s decision to mandate coverage of PrEP is so significant for these major demographics. Alongside latforms like GiveBackRX.com, PrEP is now more affordable than ever.