U.S.A.: Biden administration adds injectable PrEP requirement for insurance providers

The Biden-Harris administration announced on Monday a new mandate for insurance companies to cover injectable PrEP without requiring a co-payment from consumers. This new rule, which builds on existing Affordable Care Act guidelines, also enhances choice in contraception coverage.

“With low uptake of PrEP among the communities most impacted by HIV, this insurance coverage requirement with zero cost-sharing will help jump-start the use of more effective forms of PrEP and lead to fewer HIV transmissions,” said Carl Schmid, executive director of the HIV+ Hepatitis Policy Institute, to The Bay Area Reporter. Additionally, President Joe Biden revealed that Medicare will include this benefit for those over 65 as of September.

According to ‘LGBTQ Nation’, the rule mandates private healthcare plans to “cover every FDA-approved contraceptive drug or drug-led combination product without cost-sharing unless the plan also covers a therapeutic equivalent without cost-sharing,” according to an administration fact sheet.

A drug-led combination product involves a therapy or diagnostic delivered via a medical device like a syringe, the typical delivery method for injectable PrEP.

PrEP, short for pre-exposure prophylaxis, was first approved by the FDA in 2012 to prevent HIV infection in people exposed to the virus. Truvada was the first PrEP pill available, followed by Descovy, with the injectable PrEP Apretude approved in 2021.

Schmid from the HIV+ Hepatitis Policy Institute mentioned that the Biden administration was receptive to their lobbying efforts to remove cost-sharing for the drug.

“Without it, we feel some insurers would continue to only cover daily oral PrEP and not provide PrEP users with the choice they need,” he noted. “With up to a third of privately insured PrEP users still being charged cost-sharing, we must ensure that both federal and state regulators vigorously enforce PrEP coverage requirements.”

The new rule also eliminates co-payments for contraceptive drugs. In a statement accompanying the announcement, the Biden-Harris administration criticised Republicans for opposing women’s bodily autonomy.

“Vice President Harris and I are resolute in our commitment to expanding access to quality, affordable contraception,” said the president in a press release. “We believe that women in every state must have the freedom to make deeply personal health care decisions, including the right to decide if and when to start or grow their family. We will continue to fight to protect access to reproductive health care and call on Congress to restore reproductive freedom and safeguard the right to contraception once and for all.”