PrEP Is Now Required to Be Free Under Most Insurance Plans

Many people will soon be able to get pre-exposure prophylaxis (PrEP) for free through their health insurance plans. The medication, which can significantly help prevent HIV, is notoriously expensive, and getting a prescription requires a patient to undergo frequent lab work as well. But under new guidance from the federal government, insurers will be required to cover all costs associated with the drug, NBC News reports.PrEP, also available under the brand names Truvada and Descovy, is a type of oral medication that can help people prevent HIV infections due to unprotected sex and/or injected drug use, the Centers for Disease Control and Prevention explain. People who are currently HIV negative can take PrEP daily to reduce their risk of getting the infection.But PrEP is expensive. Truvada has an average retail price of nearly $2,000 per month without insurance, according to GoodRx. Descovy is similarly pricey, with an average retail price of around $2,300 for a 30-day supply. There are various assistance programs that make PrEP available at a lower or no cost, the CDC says, but not everyone qualifies for these programs, which don’t always cover the lab costs.That’s where the federal government’s new directive comes in: New guidance from the Centers for Medicare and Medicaid Services, the Department of Labor, and the Department of the Treasury directs health insurers to cover the cost of the medication as well as fees associated with necessary lab work. With this rule, insurers will not be allowed to charge copays, deductible payments, or coinsurance for PrEP. And they’ll have 60 days to comply.Thanks to 2019 recommendations from the U.S. Preventive Services Task Force, insurers already needed to stop charging out-of-pocket costs for PrEP by July 1, 2021. The new guidelines reiterate that rule and further clarify that insurers will be required to cover lab work costs that are incurred before the patient receives the prescription, plus follow-up monitoring and those costs associated with the medication itself. Making PrEP free will undoubtedly make it more accessible to people who need it but couldn’t otherwise afford it—even with insurance.Considering that some insurers are still not complying with the original mandate to cover out-of-pocket costs for PrEP, it’s not clear when they’ll actually start covering the other costs as well, NBC News says. But this new guidance makes it clear that it’s their responsibility to do so—and soon.Related:

Many people will soon be able to get pre-exposure prophylaxis (PrEP) for free through their health insurance plans. The medication, which can significantly help prevent HIV, is notoriously expensive, and getting a prescription requires a patient to undergo frequent lab work as well. But under new guidance from the federal government, insurers will be required to cover all costs associated with the drug, NBC News reports.

PrEP, also available under the brand names Truvada and Descovy, is a type of oral medication that can help people prevent HIV infections due to unprotected sex and/or injected drug use, the Centers for Disease Control and Prevention explain. People who are currently HIV negative can take PrEP daily to reduce their risk of getting the infection.

But PrEP is expensive. Truvada has an average retail price of nearly $2,000 per month without insurance, according to GoodRx. Descovy is similarly pricey, with an average retail price of around $2,300 for a 30-day supply. There are various assistance programs that make PrEP available at a lower or no cost, the CDC says, but not everyone qualifies for these programs, which don’t always cover the lab costs.

That’s where the federal government’s new directive comes in: New guidance from the Centers for Medicare and Medicaid Services, the Department of Labor, and the Department of the Treasury directs health insurers to cover the cost of the medication as well as fees associated with necessary lab work. With this rule, insurers will not be allowed to charge copays, deductible payments, or coinsurance for PrEP. And they’ll have 60 days to comply.

Thanks to 2019 recommendations from the U.S. Preventive Services Task Force, insurers already needed to stop charging out-of-pocket costs for PrEP by July 1, 2021. The new guidelines reiterate that rule and further clarify that insurers will be required to cover lab work costs that are incurred before the patient receives the prescription, plus follow-up monitoring and those costs associated with the medication itself. Making PrEP free will undoubtedly make it more accessible to people who need it but couldn’t otherwise afford it—even with insurance.

Considering that some insurers are still not complying with the original mandate to cover out-of-pocket costs for PrEP, it’s not clear when they’ll actually start covering the other costs as well, NBC News says. But this new guidance makes it clear that it’s their responsibility to do so—and soon.

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