IIn a groundbreaking step for the health care system, the government of Biden issued a federal mandate according to which the pre-exposure prophylaxis (PrEP) drugs Truvada and Descovy must be covered by all health insurers at no additional cost. All associated laboratory tests and clinic visits are free of charge for the insured as well.

At the beginning of the new year, the insurers had to stop the fees for the drugs. However, the HIV + Hepatitis Policy Institute has begun “spot checks” in recent months, which revealed that many insurers were failing to comply and were still charging policyholders. This updated legislation requires insurance companies to comply with the new guidelines for 60 days starting July 19, 2021, to ensure coverage for all policyholders or to take legal action.

“We are pleased that the federal government has issued this long-awaited policy to insurers that will remove the barriers to PrEP and help prevent further HIV infection while accelerating efforts to end HIV in the United States,” said Carl Schmid, managing director of the HIV + Hepatitis Policy Institute, according to the press release. “It seems that insurers have responded to our previous analysis. Now, however, we need to ensure that all of their legal requirements, including those set out in the new guidelines, are fully complied with and that federal and state regulators enforce them. “

When taken correctly by HIV-negative people, PrEP reduces the risk of contracting HIV through sex by 99 percent, according to the CDC. Currently available as a pill under the brand names Truvada and Descovy, PrEP is not a cure for HIV or prevents the transmission of other STIs or STDs. (Research into an injectable PrEP and an arm implant is ongoing.) Nearly 1.2 million Americans live with HIV, with approximately 13 percent of these people unaware of their positive status.

“As progress is made, it is clear that insurers and regulators need to do more to ensure that privately insured people can get PrEP free of charge. In addition, the transparency of how insurers present the coverage of preventive drugs such as PrEP must continue to be observed, ”said Schmid in the same statement.

The Biden government mandate is welcome news in the ongoing fight against HIV / AIDS, but it does not change access to the drug for the uninsured, which still puts millions of Americans at risk. “We look forward to performing additional plan reviews and holding all parties responsible for providing clear, transparent information to make access as easy as possible for those insured who need PrEP,” said Schmid.

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