USPSTF HIV Prevention Recommendation Could Mean Added Insurance Coverage

The grade A recommendation for PrEP will require insurers to cover the daily pill with no cost sharing

Insurance coverage with no cost sharing may be one important practical consequence of the U. S. Preventive Services Task Force's grade A recommendation of PrEP this week.

ACA requires private insurers to cover preventive services with an A or B recommendation from the USPSTF.

The USPSTF grade A recommendation for preexposure prophylaxis was published yesterday in JAMA. The only FDA-approved PrEP is Gilead's Truvada, a pill that combines tenofovir and emtricitabine. Several months ago, Gilead agreed to donate Truvada for treatment of up to 200,000 uninsured people. Without coverage, treatment with the pill can cost up to $2,000 a month. PrEP is important of the Trump administration's promise to end the HIV epidemic by 2030.

In accompanying editorial in JAMA,  Rochelle Walensky, a Harvard AIDS researcher, and A. David Paltiel, a professor at the Yale School of Public Health, said the new grade A recommendations "will open the doors to PrEP and its associated services. This is a big step forward and is sufficient cause to applaud the USPSTF for its leadership."

But they also noted the many barriers to adhering to PrEP—mental illness, HIV stigma, the complexity of the health care system—and cited CDC figures that show that only 73% of people who know they are infected are receiving care and only 60% are HIV suppressed. They estimated that just the drug component of PrEP would would cost $24 billion annually.

The USPSTF recommendation cited an CDC estimate that 1.2 Americans were eligible for PrEP in 2015 but only about 100,00 were using it as of 2017.