Feds call on insurers to fully cover HIV prevention drug PrEP without cost-sharing

The Biden administration issued guidance Monday directing most insurers to offer pre-exposure prophylaxis (PrEP) to beneficiaries at no cost.

The guidance released Monday by the Department of Labor comes after HIV patient advocacy groups have found that insurance plans have been slow to offer preventative drugs without cost-sharing obligations.

“We are pleased that the federal government has issued this long-awaited guidance to insurers that will reduce barriers to PrEP and help prevent further HIV infections while advancing efforts to end HIV in the United States,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute in a statement Monday.

The Biden administration warned insurers they have 60 days to come in compliance with the no cost-sharing requirement. The Affordable Care Act requires any non-grandfathered health plans and any group or individual market plans to offer without cost-sharing any preventive drugs that get a recommendation from the U.S. Preventive Services Task Force.

The PrEP requirement went into effect in January, but insurers were slow to update their processes, according to an estimate released late last year from the HIV+Hepatitis Policy Institute.

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The analysis found that most of the plans offered on the ACA’s exchanges that were examined did not offer the drugs free of cost-sharing requirements.

A follow-up earlier this year found that “many plan formularies have been updated and almost all are offering at least one PrEP drug without cost-sharing,” the institute said in a statement.

The guidance emphasizes that plans also have to cover without cost-sharing any preventive services too, including for PrEP.

The guidance said that the federal government will refrain from penalizing any insurers who fail to provide this coverage for 60 days.