A Major Rule to Expand HIV Prevention Access is Proposed

A proposed rule by the current administration could dramatically improve access to HIV prevention by requiring private health insurers to cover an injectable form of pre-exposure prophylaxis (PrEP) without cost-sharing.  If finalized, this policy would represent a pivotal step in addressing the HIV epidemic and reducing healthcare disparities among underserved communities.

This proposal, which builds on previous guidance for the Affordable Care Act, complements broader changes intended to increase access to contraception and other preventative measures, like requiring many health insurance plans to cover over-the-counter contraceptives without a prescription. These changes represent a significant stride forward in making prevention strategies more inclusive, affordable and accessible to all.

Tackling Disparities in PrEP Access

Currently, PrEP is available in oral form and has proven highly effective, yet adoption rates vary widely. Federal research reveals that PrEP access has been uneven across demographics:

Injectable PrEP has the potential to address adherence challenges associated with the daily pill regimen. Research has shown the effectiveness of long-acting options that reduce the frequency of doses. For example, one injectable, cabotegravir (Apretude), requires bimonthly dosing, while another, still awaiting FDA approval, could be administered twice annually. With no daily pill to remember, these injectables have the potential to improve uptake and adherence, especially once covered by insurance – a development widely anticipated by community health leaders.

Expanding Prevention Access
The proposed rule would remove financial barriers by requiring insurers to cover these injectables without cost-sharing, ensuring equitable access across communities most impacted by HIV.

Why This Matters
Since injectable PrEP is a service Prism Health North Texas offers, we wanted to share this proposed rule and its potential impact on HIV prevention. If finalized, this policy could expand access to preventive care, reduce barriers for underserved communities, and play a critical role in addressing the HIV epidemic.

The proposed rule is currently open for public comment for 60 days. For those interested in reviewing or contributing feedback, you can access the full proposal and comment submission portal here through December 20, 2024.