According to the CDC, around 38,000 Americans contract HIV each year. But fortunately, there are now drugs available that can help prevent becoming infected with HIV, including Truvada and Descovy, known as PrEP drugs. Unfortunately, these drugs have been so expensive that they have been out of reach for many people: they can cost as much as $1,800 a month! But all of that is set to change: new rules are mandating that most insurers cover the cost of these drugs, as well as associated clinic visits and lab work.
The Mandate
After looking at the research surrounding HIV prevention drugs, which shows that each drug is 99% effective at preventing HIV infection, the Biden Administration has decided to mandate coverage for these medications. Most insurers must now completely cover the cost of the drugs and, as of Sept. 19, 2021, must also cover the cost of the services associated with them, including regular HIV tests and doctor’s office fees, according to new rules from the Centers for Medicare and Medicaid Services.
Hundreds of thousands of people could benefit from the new mandate, especially African Americans and other people of color, who are much more likely than whites to be diagnosed with HIV, but much less likely to talk with a healthcare provider about the drugs.
“Now it is important that people who are eligible for PrEP, along with their providers, are aware of these new requirements,” Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, said of the new guidance to insurers regarding PrEP-related cost-sharing. “We also have to hold insurers accountable to ensure they are doing their job in complying with their legal obligations. Plan reviews still show many insurers are not in compliance, and we need state insurance regulators to enforce the law and the new guidance.”
Descovy and Truvada, often referred to as PrEP, for “pre-exposure prophylaxis,” are approved for men at high risk of acquiring HIV through unprotected sex or injection drug use. Truvada is also approved for women.
What If You Don’t Have Insurance?
Even if you don’t have insurance, or your current plan will not cover the drugs, there is still hope! The generic form of Truvada, which is just as effective, can cost as little as $30 a month!
In addition, you should look into Ready, Set, PrEP, a federal program that offers Descovy and Truvada free to anyone without insurance, regardless of their income level, as long as they have a Social Security number and a prescription. You can apply by calling 855-447-8410.
Once approved, you can fill the prescription at any participating pharmacies, including Albertsons, CVS, Rite Aid, Vons, Walgreens, and Walmart.
Carolyn Chu, MD, chief medical officer at the American Academy of HIV Medicine, says “A significant component of ending the HIV epidemic is ensuring that, in addition to medication coverage, communities most at risk for HIV and those with the greatest need have access to care that is free from stigma, and delivered by providers who understand the experiences of the community.”
Looking For An Affordable Plan?
If you don’t have health insurance, or your plan does not cover these drugs, you can find an affordable plan that does with EZ’s help. We offer a wide range of health insurance plans from top-rated insurance companies in every state. And because we work with so many companies and can offer all of the plans available in your area, we can find you a plan that saves you a lot of money – even hundreds of dollars – even if you don’t qualify for a subsidy. There is no obligation, or hassle, just free quotes on all available plans in your area. To get free instant quotes, simply enter your zip code in the bar above, or to speak to a local agent, call 888-350-1890.
