ACA: Most insurers will cover HIV prevention meds with no out-of-pocket cost |
Harrisburg, Pa. — Following World AIDS Day, the Pennsylvania Insurance Department wants to remind the public of a HIV prevention medication available through most insurers.
PrEP is short for HIV pre-exposure prophylaxis. These medications prevent the spread of HIV by preventing the virus from replicating in the body. The drug is highly recommended for those who may have a sexual partner with HIV or who use injectable drugs.
Under the Affordable Care Act, the federal government requires most insurers to cover PrEP with no out of pocket copay, deductible, or coinsurance. In addition, tests, doctor visits, and other services directly related to obtaining PrEP are required to be covered with no out-of-pocket costs.
A September 2022 federal court case determined that some businesses and insurance providers may be exempt from covering PrEP for religious reasons. Anyone who has received HIV PrEP medication and was charged a copayment, coinsurance, or deductible may still contact their health insurer to request a refund. Otherwise, if you are uninsured or your insurance doesn’t cover PrEP, you may be eligible for assistance.
Coverage requirements include brand names like Truvada and Descovy, insurers may require prior authorization to confirm that a specific brand name drug is medically necessary before qualifying for zero-cost coverage.
“To end the HIV epidemic in Pennsylvania and the United States, we need to work together to increase awareness, reduce stigma, and improve access to live-saving medications like PrEP, said Dr. Katharine Dalke, commissioner for the Pennsylvania Commission on LGBTQ Affairs. “Thankfully, PrEP is covered by insurance in our state and is accessible to patients who need it.”
Those who are uninsured are advised to explore coverage options through Pennie, Pennsylvania’s official online health insurance marketplace. Enrollment is now open and will remain open through January 15, 2023. December 15 is the deadline to obtain coverage that begins on January 1, 2023. Otherwise, coverage will begin on February 1.
Read More: ACA: Most insurers will cover HIV prevention meds with no out-of-pocket cost |