The federal government requires health insurers to cover the cost of HIV preventive drugs and related care, but some patients are still paying for these services, Kaiser Health News reported March 3.
Six takeaways:
1. In 2019, the U.S. Preventive Services Task Force designated HIV preexposure prophylaxis, or PrEP, as an effective preventive service, triggering provisions for insurers to cover it under the Affordable Care Act. The new coverage rule took effect in 2021.
2. After receiving pushback from insurers, the Department of Labor issued a clarification in July 2021, stating that insurers must cover any medical care related to PrEP, such as laboratory tests and physician appointments.
3. However, some patients are still receiving bills for these services, and many people do not realize they don't have to pay out of pocket, HIV advocates and clinic employees in six states told KHN.
4. Insurers are also setting up drug formularies in a way that makes it look like patients will have to pay, according to Carl Schmid, executive director of the HIV+Hepatitis Policy Institute.
"That's one of the barriers," he told KHN. "They are not showing this is free for people in an easy way."
5. State insurance commissioners and the Department of Labor are responsible for enforcing coverage rules, but such oversight is largely driven by patient complaints, according to Amy Killelea, a lawyer specializing in HIV policy and coverage.
6. Patients with concerns about their insurance plan's compliance with the coverage rules should contact the department's Employee Benefits Security Administration, spokesperson Victoria Godinez told KHN.