Biden administration adds injectable PrEP requirement for insurance providers

The Biden-Harris administration announced Monday a new requirement for insurance providers to cover injectable PrEP in their policies without a co-payment for consumers. The new rule, built on previous guidance for the Affordable Care Act, also applies to increased choice in contraception.

“With low uptake of PrEP among the communities most impacted by HIV, this insurance coverage requirement with zero cost-sharing will help jump-start the use of more effective forms of PrEP and lead to fewer HIV transmissions,” Carl Schmid, executive director of the HIV+ Hepatitis Policy Institute, told The Bay Area Reporter.

Related:

A new HIV-prevention injection just succesfully completed its clinical trials

The twice a year shot had 100% efficacy, but a few hurdles remain before it becomes publicly available.

President Joe Biden announced the same benefit added to Medicare coverage for those over 65 in September.

Never Miss a Beat

Subscribe to our newsletter to stay ahead of the latest LGBTQ+ political news and insights.

Daily

Weekly

Good News

The rule requires private healthcare plans “to cover every FDA-approved contraceptive drug or drug-led combination product without cost-sharing unless the plan also covers a therapeutic equivalent without cost-sharing,” according to a fact sheet issued by the administration.

A drug-led combination product is a therapy or diagnostic drug delivered by a medical device, including a syringe, the standard delivery device for injectable PrEP.

PrEP, or pre-exposure prophylaxis, was first approved by the FDA in 2012 to prevent people exposed to HIV from becoming infected with the virus. Truvada in pill form was the first prescriptive PrEP to hit the market, followed by Descovy. The injectable PrEP Apretude was approved in 2021.

HIV+ Hepatitis Policy Institute’s Schmid said the Biden administration was receptive to the group’s lobbying for the elimination of cost-sharing for the drug.

“Without it, we feel some insurers would continue to only cover daily oral PrEP and not provide PrEP users with the choice they need,” he said. “With up to a third of privately insured PrEP users still being charged cost-sharing, we must ensure that both federal and state regulators vigorously enforce PrEP coverage requirements.”

The new rule comes with the same co-payment elimination for contraceptive drugs. In a statement accompanying the announcement, the Biden-Harris administration criticized Republicans for their opposition to women’s bodily autonomy.

“Vice President Harris and I are resolute in our commitment to expanding access to quality, affordable contraception,” the president said in the press release. “We believe that women in every state must have the freedom to make deeply personal health care decisions, including the right to decide if and when to start or grow their family. We will continue to fight to protect access to reproductive health care and call on Congress to restore reproductive freedom and safeguard the right to contraception once and for all.”

Subscribe to the LGBTQ Nation newsletter and be the first to know about the latest headlines shaping LGBTQ+ communities worldwide.

Don't forget to share: