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A new study by CUNY SPH researchers suggests that insurance and cost-related barriers persist for sexual and gender minority people seeking pre-exposure prophylaxis (PrEP), despite regulations intended to make the drug affordable and accessible.
PrEP is an effective and essential HIV prevention strategy, critical for reducing HIV transmission in the U.S. Consequently, the drug has received a “grade A” designation from the United States Preventive Services Task Force (USPSTF), requiring most insurers to cover the cost of PrEP and related care without cost-sharing with patients.
However, the study of over 11 thousand sexual and gender minority individuals from across the U.S. found widespread instances of both insurance denials and cost-sharing among current and former PrEP users, with 23.7% reporting an insurance denial for PrEP (ever), and over one-third (34.6%) having experienced cost-sharing for their PrEP or related care in the prior two years.
“We are still seeing instances of denials and cost-sharing for PrEP—even despite coverage regulations from the USPSTF—and that’s cause for concern,” says CUNY SPH Distinguished Professor Christian Grov, the study’s principal investigator. “We want PrEP to be maximally accessible, and insurance and cost barriers undermine that goal.”
The study found that insurance denials ranged from as high as 48.2% for brand-name Descovy and 33.4% for brand-name Truvada, to 8.5% for generic, TDF/FTC-formulated PrEP. Meanwhile, the majority of cost-sharing experiences were reported for lab work, and by those with private insurance.
The authors offer several possible explanations for persisting coverage issues, including insurers selectively denying coverage or sharing costs to incentivize the use of some drugs over others, and coverage exemptions for ACA-noncompliant plans—though they note that these data cannot support causal claims in this regard and more research is needed.
“It’s important to ground these data in the current moment, where things are looking uncertain for the USPSTF under the leadership of HHS secretary, RFK Jr., who’s threatening to disband the panel of experts,” says first author and recent CUNY SPH doctoral graduate Alexa D’Angelo. “While our data may highlight the limits of coverage regulations at the time, they’re incredibly important protections for PrEP-users. We should be expanding patient protections, insurance coverage and funding sources for PrEP, not upending a critical regulatory body on preventive healthcare services.”
