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Health Insurers Must Cover PrEP at Zero Cost to Patients, Agencies Clarify

September 27, 2021

Author

Jennifer Wessel, JD, MPH
Senior Policy Analyst and Data Privacy Officer
501-526-2244
JBWessel@achi.net

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Pre-exposure prophylaxis (PrEP) for the prevention of HIV and associated services must be free to patients, according to a list of frequently asked questions (FAQs) authored by three federal government agencies.

This policy is the result of a recommendation issued by the U.S. Preventive Services Task Force in 2019. The task force recommended that clinicians offer PrEP with effective antiretroviral therapy to persons who are at high risk of HIV acquisition. The Affordable Care Act requires health insurance plans to cover recommended preventive services without any patient cost-sharing.

The FAQs clarifying the coverage requirements for PrEP were prepared jointly by the Labor, Health and Human Services, and Treasury departments. Previously, the cost of PrEP has often been a barrier to use. Even if the medication — Truvada and Descovy are the two approved medications for PrEP — was covered under a patient’s insurance coverage, office visits and lab tests could add to the costs.

For patients without insurance, other programs are available to cover the cost of PrEP care.

Nineteen percent of Arkansans with HIV are unaware they have the virus, according to the Centers for Disease Control and Prevention. In addition, nearly 5,000 Arkansans are at high risk for HIV and could potentially benefit from PrEP. In 2018, PrEP was prescribed to 611 Arkansans.

For more information on HIV in Arkansas, see our explainer.