Task Force Says People at High Risk of Getting HIV Need Easy Access to PrEP

If the draft recommendation is approved, insurers will have to cover the medication without charging copays or deductibles.

In a move that’s expected to expand insurance coverage for an HIV prevention pill, an advisory panel of the U.S. Preventive Services Task Force (USPSTF) recently said that doctors should encourage patients who are at high risk of contracting HIV to take Truvada (also known as PrEP). The panel noted that an estimated 1.1 million people in the U.S. are currently living with HIV. James Krellenstein, a founding member of the Prevention of HIV Action Group at ACT UP/New York, tells Stat that the agency’s recommendation is huge. “If the recommendation is adopted, all insurance companies are going to be required to cover PrEP and they won’t be able to charge any cost sharing,” says Krellenstein, referring to copays and deductibles.

CDC officials hope that adoption of the proposal will allow PrEP to fulfill its therapeutic potential in that not everyone can afford the medication. It costs $1,675, which represents a 45% increase in cost in six years. Gilead, which makes the drug, maintains that cost has not been a barrier, citing a CDC study saying that less than 1% of people who can benefit from the pill need financial assistance.

The USPSTF “found convincing evidence that PrEP is of substantial benefit in decreasing the risk of HIV infection in persons at high risk of HIV infection, either via sexual acquisition or through injection drug use,” the draft recommendation states. “The USPSTF also found convincing evidence that adherence to PrEP is highly correlated with its efficacy in preventing the acquisition of HIV infection.”

The USPSTF will accept public comment on the draft recommendation until December 26. The recommendation says that certain behaviors put people at high risk of HIV. It said that “receptive anal intercourse without a condom and needle-sharing injection drug use carry the highest risk, while insertive anal intercourse, receptive penile-vaginal intercourse, and insertive penile-vaginal intercourse carry lower but not negligible risks of acquiring HIV from a partner or source who is seropositive for HIV.”