Evaluating the Current and Future Opportunities for HIV PrEP - Episode 15

US Preventive Services Task Force’s Recommendation for PrEP

Carl Schmid explains the implications of PrEP therapies receiving a Grade A recommendation from the US Preventive Services Task Force.

Carl Schmid: Having a Grade A recommendation from the United States Preventive Services Task Force for PrEP [pre-exposure prophylaxis] is amazing news. It puts the moniker or seal of approval that this is a preventive service that all providers should follow. It also says that because of the Affordable Care Act and its focus on preventive services, all insurers have to cover PrEP. On top of that, they have to cover it with no cost-sharing for patients. This is extremely important. The federal government has also come out with guidance saying that it’s not only free for the drug, that all the laboratory services and medical visits are free as well. It’s very much like a colonoscopy. You don’t pay anything for the colonoscopy. But what about the anesthesia? What about the removal of the polyp? What about the office visit? There’s no cost-sharing. The federal government has interpreted the Affordable Care Act and the same is true for PrEP and all the associated PrEP services.

This is a game-changer. It should make it more available. Providers should be offering PrEP to every patient who’s sexually active, and at least discussing it with them. Even though we have this in place, it’s not always a reality. We’re still seeing insurers not putting at least 1 PrEP drug without cost-sharing on their formularies. We’re also hearing a lot of cases of insurers still charging their patients for the drug or the laboratory services and medical visits. We need the payers to be compliant with this legal requirement. We’re also calling on the state insurance commissioners to make sure that the plans in their states are in compliance as well. It’s great news. Unfortunately, it’s only covering the oral drugs, but the United States Preventive Services Task Force is also undertaking a review of the long-acting drug. Hopefully that will be covered without cost-sharing in the future as well.

This transcript has been edited for clarity.