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PrEP, the HIV prevention pill, about to become 100% free for the insured

·3 min read
PrEP, the HIV prevention pill, about to become 100% free for the insured
PrEP, the HIV prevention pill, about to become 100% free for the insured

Thirty years ago, it might have seemed unimaginable that a one-a-day pill would someday reduce the risk of getting HIV by as much as 99%.

Now that life-changing drug will be totally, completely free for millions of Americans.

Earlier this month, the federal government told health insurers that any and all medical expenses associated with PrEP — not just the medication itself — must be covered without cost sharing.

That means just about everyone who can afford health insurance will never have to pay a dime for protection — and it’s not the only treatment being covered this way.

Insurers have just weeks to comply

Serious \ businessmen sit in office look at laptop screens.
fizkes / Shutterstock

On July 19, the federal government told health insurers they had 60 days to start covering all costs of receiving either of the approved HIV-prevention pills — namely, Truvada and Descovy.

That’s everything from the initial doctor’s visit to all follow-up bloodwork and medical appointments.

Insurance providers had already been required to stop charging out-of-pocket fees for the medication by Jan. 1.

Between 2015 and 2019, as the use of PrEP (pre-exposure prophylaxis) became more widespread, the U.S. saw an 8% drop in the annual rate of HIV transmissions, the CDC says.

But the uptake hasn’t been as fast as it could be. The CDC once estimated that 1.1 million Americans could benefit from the drug; it reported in May that some 285,000 people are actually using it.

Access may get harder for the uninsured

Blurry clinic
CCL STUDIO / Shutterstock

The federal government’s decision is great news for those with health insurance coverage who may have held off on getting a prescription because of the additional costs.

At the same time, accessing PrEP may soon become much more difficult for people without insurance. Gilead, the manufacturer of both Truvada and Descovy, is planning policy changes next year that are expected to drain funding from frontline clinics serving low-income communities.

“It’s going to put a lot of our programs in serious harm’s way at best,” Jim Pickett, senior director of prevention advocacy and gay men’s health at AIDS Foundation Chicago, told NBC. “Some of them will be decimated and destroyed.”

Other treatments covered free of charge

Male patient having consultation with doctor.
Chinnapong / Shutterstock

The new requirements for health insurers come courtesy of an “A” rating for PrEP by the U.S. Preventive Services Task Force.

Under the Affordable Care Act, any preventative service granted an A or B rating by the task force must be totally covered by almost all insurers for the good of the country.

Other procedures free of charge for people with a health insurance plan include:

  • Screening for depression, diabetes, cholesterol, obesity, various cancers, HIV and sexually transmitted infections.

  • Counseling and medication to help people off drugs and tobacco and embrace healthy eating.

If you need help covering medical costs

Two men sitting on a couch, looking seriously at a smartphone.
Gorodenkoff / Shutterstock

Unfortunately, health insurance itself is far from free, but you may have a few options to reduce your premiums.

In addition to choosing a higher deductible or higher copays, your most powerful tool with marketplace plans is simply shopping around. The Insurance Information Institute recommends comparing at least three quotes to ensure you don’t end up overpaying.

That’s easy enough to do using a quote comparison site. All you’ll have to do is answer a few questions and then review your options.

You can use the same approach to slash your other insurance premiums. Switching to a different auto insurance policy could reduce your costs by up to $1,000 a year. And you could trim a similar amount from your homeowners insurance bill, as well.

Finally, if you can afford it and you have dependents who rely on your income, consider pouring any excess savings into an affordable life insurance policy. It's much better to take out a policy while you're younger and healthier, as you're less likely to be denied coverage and more likely to lock in a low rate.