The PrEP Access and Coverage Act would require all private and public insurance plans to cover the HIV prevention pill and related services with no out-of-pocket costs for patients.
According to the Centers for Disease Control and Prevention (CDC), there are more than 1.2 million Americans currently living with HIV and nearly 37,000 people are newly diagnosed in the United States each year. Two-thirds of those new infections are among gay and bisexual men, and disproportionately affect Black and Latinx gay and bisexual men. While data on the transgender community remains scarce, a systemic research review in 2019 found that an estimated 14 percent of transgender women in the United States are living with HIV.
Recent advances in HIV prevention and treatment have decreased new HIV infections and increased access to care and treatment are helping people living with HIV achieve and maintain viral suppression. Pre-exposure prophylaxis, or PrEP, is a once-a-day pill that effectively prevents transmission of the HIV virus when taken as prescribed. In addition, if a person living with HIV is on medication that reduces the amount of virus in their body to undetectable levels, they cannot transmit the virus to their partners and can expect to live near normal life expectancies.
The high cost of this critical preventive medication (as much as $20,000 per year), along with copays and attendant lab fees impede patient access to PrEP. In addition, research has shown that the lack education about PrEP among physicians is a barrier to risk individuals receiving the preventive medication they need.
The PrEP Access and Coverage Act would require all private and public insurance plans to cover the HIV prevention pill and related services with no out-of-pocket costs for patients. The bill would also enhance access for the uninsured. It would fund a grant program to assist states, territories, and tribal communities in promoting access to PrEP for the uninsured and reducing disparities in access to the prevention medication. The grants would also support outreach to physicians and other providers designed to increase understanding of PrEP and the recommended clinical practices for providing care. The legislation also bars companies selling life insurance, disability insurance, and long-term care insurance from denying coverage to or charging higher premiums for people taking PrEP. Additional grants would be made available for a public education campaign to reduce disparities in access to and use of PrEP through education—particularly in high-need communities in which PrEP is underutilized—about the safety and efficacy of the drug and to combat stigma surrounding PrEP usage.
The PrEP Access and Coverage Act was introduced in the House of Representatives by Rep. Adam Schiff (D-CA) on July 17, 2019 and in the Senate by Sen. Kamala Harris (D-CA) on June 20, 2019.
The PrEP Access and Coverage Act has yet to be reintroduced in the 117th Congress.
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Last Updated: March 22, 2021
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