US Insurers Are Still Charging for HIV Prevention Pills That Should Be Free

The Washington Post reports on tens of thousands of Americans 'forced to pay for medication' to prevent the HIV infections, 'despite federal requirements guaranteeing free access to treatment...according to multiple studies and interviews with medical professionals, activists and patients.'

Insurance companies are skirting rules compelling them to pay for pre-exposure prophylaxis treatment, known as PrEP, researchers and HIV advocacy organizations say — leaving patients to shell out hundreds of dollars each year for medication co-pays, doctor visits and screenings required to stay on drugs that reduce the risk of contracting HIV through sex by 99 percent.

Under the Affordable Care Act, commercial insurers must cover certain preventive health services. This is supposed to include at least one form of oral PrEP and related health services, such as regular testing for HIV and other sexually transmitted diseases, for people at increased risk of contracting HIV, according to 2021 guidance from the Biden administration. Responding to complaints that patients were still being charged, the Biden administration in October released new guidance instructing private insurers to cover all forms of PrEP without prior authorization, including new long-acting injections.

Nearly a third of a national sample of 325 health coverage plans on government insurance marketplaces did not include PrEP on their lists of covered preventive services, according to the AIDS Institute, a New York-based nonprofit. Between 20 and 30 percent of PrEP users with commercial insurance still had to pay for it despite the coverage mandate, with an average cost of $227 for 2022, according to the Centers for Disease Control and Prevention. Government regulators have been slow to crack down on insurer violations, activists say, creating a barrier to getting more at-risk Americans on the medication. The CDC estimates that only a third of the more than 1 million people who could benefit from PrEP have received a prescription, according to its most recent data.
The issue appears to be lax enforcement against insurers who break rules, a policy advocate told the newspaper. America's Centers for Medicare and Medicaid Services, which enforces regulations for preventive care, 'said it takes enforcement seriously and recently found two insurance plans in violation of coverage requirements following consumer complaints.'

And the Post spoke to an official at America's Labor Department, who said they were investigating a complaint against a large insurance company, but 'said the agency does not have enough staff to conduct proactive investigations and lacks the authority to sue and penalize insurers that break the rules.'

Read more of this story at Slashdot.