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Presidential Council Urges HHS to Step Up PrEP Efforts


Letter from co-chairs Marlene McNeese and John Wiesman urges enforcement of coverage rules, including zero cost sharing for those with private insurance.

The Presidential Advisory Council on HIV/AIDS recently made recommendations to scale up preexposure prophylaxis (PrEP) efforts.

In a letter to HHS Secretary Xavier Becerra, the council urged the Biden administration to support the creation of a national PrEP program so all those who eligible for taking antiviral medications on a preventive basis have access to the medications and any associated services.

Only then, argued the council, would the administration’s Ending the HIV Epidemic in the U.S. (EHE) initiativebe considered a success.

“Establishing a national PrEP program will allow communities across the country to help meet the goal in the strategic plan to increase PrEP coverage to 50% by 2025,” co-chairs Marlene McNeese and John Wiesman wrote in the letter. “It will also help address ongoing racial and ethnic disparities and decrease new HIV infections.”

One of the chief recommendations was in addressing racial, ethnic and other inequities.

Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, who contributed to the recommendations, notes this is vital as only about 1 in 4 of the approximately 1.2 million people who might benefit from PrEP are currently receiving it.

Data from 2019 show that 8% of Black people and 14%of Latino people who were eligible for PrEP were prescribed it compared with 63% of white people, according to the letter.

“In order to ensure PrEP uptake is increased among certain populations and communities, all PrEP programs and efforts must first prioritize those communities and areas of the country that are most in need of PrEP and currently not utilizing it,” says Schmid.

The letter urges HHS to make sure that “all payers cover PrEP and associated services to the fullest extent possible under the law,” which includes zero cost sharing for those people with private insurance.

“We urge you to ensure insurers are in compliance with the guidance CCIIO (the Center for Consumer Information and Insurance Oversight) issued on July 19, 2021, and that new PrEP drugs, such as the long-acting injectable, be covered as quickly as legally possible,” the co-chairs wrote. “We also urge that similar guidance be issued for Medicaid and Medicare programs.”

The letter also says the national PrEP effort should take advantage of the 340B program: 

“The program should be designed to allow for the lower cost purchase of PrEP medications via the 340B drug pricing program, the utilization of generic PrEP, and free PrEP medication programs, PrEP peer navigation programs, PrEP marketing campaigns, and other culturally-relevant programs as appropriate,” the letter reads. “Funding of innovative strategies that effectively decrease PrEP usage disparities will be critical to close the widening racial and gender disparities of PrEP usage.”

The letter was unanimously adopted by council at its meeting, conducted virtually, on March 15, 2022. As of April 29, HHS has not delivered an official response. However, President Biden’s most recent budget proposal includes nationwide PrEP delivery program, along with significant boosts for HIV funding.

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