June 20, 2019

Harris Introduces Bill to Dramatically Expand Access to PrEP

Bill requires all private and public insurance plans to cover revolutionary HIV prevention drug and related services with no out-of-pocket costs, also facilitates access to PrEP for uninsured.

WASHINGTON, D.C. – U.S. Senator Kamala D. Harris (D-CA) on Thursday introduced the PrEP Access and Coverage Act, legislation to dramatically expand Americans’ access to pre-exposure prophylaxis (PrEP), medication that when taken daily reduces the risk of HIV infection by up to 92%.

HIV disproportionately impacts gay and bisexual men, transgender women, and, in particular, people of color. Members of communities at the intersections of these groups are most heavily impacted. A generic form of PrEP is expected to enter the market in 2020, but the high cost of the medication—combined with out-of-pocket costs for follow-up visits and lab testing—places barriers between PrEP and the more than 1 million people who would most benefit from it. 

“PrEP is a critical advancement in the fight against HIV that can finally provide peace of mind to Americans who live in the shadow of the HIV epidemic. But for too many in our country, lack of insurance coverage and steep costs have put PrEP out of reach—and that needs to change,” said Harris. “We must truly commit ourselves to HIV prevention by finally requiring every health insurance plan—public and private—to cover PrEP and all of the required tests and follow-up doctors’ visits. We must also provide the resources necessary to help people without insurance access PrEP. Nearly four decades since the beginning of the HIV/AIDS crisis that took so many lives and caused countless others to live in fear, we can and will stop the spread of this disease.”

On June 11, 2019, the U.S. Preventive Services Task Force (USPSTF) gave PrEP an “A” rating as a preventive service. This rating means that private insurance companies will have to cover PrEP without cost-sharing for those individuals by 2021. Harris’ legislation goes further by requiring that all private and public insurance plans—including Medicare and Medicaid—cover without a copay not only the drug itself but also all associated doctors’ visits, tests, and monitoring recommended by the U.S. Public Health Service.

The PrEP Access and Coverage Act would:

  • Require all public and private health insurance plans to cover the drug—as well as all required tests and follow-up visits—without a copay, just as the Affordable Care Act requires insurance to cover contraception and other preventive services.
  • Fund a grant program to assist states, territories, and tribal communities in facilitating access to PrEP for people who lack insurance and reducing disparities in access to PrEP. The bill authorizes grants to cover the cost of the drug, as well as all associated tests and follow-up visits. The grants will also support outreach to physicians and other providers designed to increase understanding of PrEP and the recommended clinical practices for providing care.
  • Prohibit companies selling life insurance, disability insurance, and long-term care insurance from denying coverage to customers who take PrEP or charging them higher premiums.
  • Fund a public education campaign to reduce disparities in access to and use of PrEP by educating the public—particularly high-need communities in which PrEP is underutilized—about the safety and efficacy of the drug and to combat stigma associated with using PrEP.

Supporters of the PrEP Access and Coverage Act include AIDS United, Human Rights Campaign, Lambda Legal, and the National Alliance of State and Territorial AIDS Directors.

“Ending the HIV epidemic in the U.S. requires effective, comprehensive, affordable, and sustainable public health strategies. Our strategies must break down barriers and strengthen access. Discriminatory policies by the insurance industry are a significant barrier and so are underfunded public health programs.  Responding to the needs of people living with HIV is one of the greatest examples of effective public health in our country’s history, but  we need now more than ever a similar approach for people vulnerable to HIV. PrEP is a gamechanger, because it is over 92% effective at preventing HIV.  Yet barely 20% of the more than a million people most vulnerable to HIV are actually getting it.   Those who lack access to PrEP are overwhelmingly gay men of color, especially in the south.  If our policies and public health program systems don’t help the most vulnerable among us—we must strengthen or rebuild them, because continuing to fail communities who have been historically left behind  is no longer just or acceptable. We must ensure access to PrEP for all populations, including young Black and Latino gay men, women, and transgender individuals who are at highest risk for HIV.  That means building systems and creating policies like those proposed by Senator Harris’ PrEP legislation.  Her legislation  will provide access to PrEP for all populations and, importantly, mandate that insurance plans cover necessary costs including STD testing, lab and medical expenses. Her proposal makes the gamechanger of PrEP even more real,” said Jesse Milan, Jr., JD, President & CEO, AIDS United.

 “Lambda Legal is thrilled to support this bill, which will not only make PrEP accessible to thousands upon thousands of people at higher risk for HIV, but will also ensure that life, disability and long-term care insurance companies stop discriminating against PrEP users merely for taking appropriate measures to protect their health.  We are hopeful that a common sense measure like this—one that will save the government millions of dollars over time—will fly through Congress!” said Scott Shoettes, HIV Project Director, Lambda Legal.

“Expanding access to PrEP is central to ending the HIV and AIDS epidemic,” said J. Maurice McCants-Pearsall, Director of HIV & Health Equity at the HRC Foundation. “Senator Harris’ bill helps ensure that communities disproportionately impacted by HIV, particularly Black and Latinx gay and bisexual men and transgender women, are guaranteed insurance coverage for life-saving preventive interventions and the requisite follow-up and monitoring, while also expanding access for those who are uninsured. We thank Senator Harris for sponsoring this lifesaving and innovative legislation.”

“We cannot end the HIV epidemic without dramatically scaling up access to PrEP. This bill includes a comprehensive and unprecedented set of non-discrimination and access protections aimed at tackling the formidable stigma, coverage, and cost barriers to PrEP.  Funding for a national PrEP program—that includes resources to support medication, labs, and clinical services—is also critically necessary to scale up PrEP in communities disproportionately impacted by HIV. NASTAD applauds the leadership of Senator Harris and her commitment to ending new HIV infections in this country,” said Amy Killelea, JD, Senior Director, Health Systems Integration, National Alliance of State and Territorial AIDS Directors.

For further background on the bill, click here.

For full bill text, click here.