Harris Introduces Bill That Would Require All Insurance Plans to Cover PrEP and Related Services

Senator Kamala Harris, D-California, has released a bill to dramatically increase access to pre-exposure prophylaxis (PrEP). The PrEP Access and Coverage Act would require all private and public insurance plans to cover the HIV prevention pill and related services with no out-of-pocket costs for patients. The bill would also enhance access for the uninsured.

The bill comes a week after the United States Preventive Services Task Force issued a grade A recommendation for PrEP, which means private insurance companies will have to cover the pill by 2021. It also comes a month after Gilead, which markets the only FDA-approved PrEP pill, Truvada, announced that a generic version of its pill will come to market a year early in 2020 and that it will donate Truvada for up to 200,000 people for up to 11 years. However, reactions to Gilead's announcement were mixed as the pill costs $1675 a month, or approximately $20,000 a year, in addition to the costs of follow-up visits and lab testing. The price has drawn criticism from HIV/AIDS activists who say the drug can be manufactured at a fraction of the price.

“PrEP is a critical advancement in the first 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 in a statement. “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.”

In addition to requiring all plans to cover the pill and related services, the bill would:

• Fund a grant program to assist states, territories, and tribal communities in promoting access to PrEP for the uninsured and reducing disparities in access to the pill. The grants would 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 or charging higher premiums for people taking PrEP.
• Fund a public education campaign to reduce disparities in access to and use of PrEP through education—particularly in high-need communities in which PrEP is underutilized—about the safety and efficacy of the drug and to combat stigma surrounding PrEP usage.

AIDS activists, including AIDS United, HRC Foundation, Lambda Legal, and the National Alliance of State and Territorial AIDS Directors, have come out in support of the bill.

“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,” Amy Killelea, JD, senior director of Health Systems Integration at the National Alliance of State and Territorial AIDS Directors, said in a statement.

Jesse Milan Jr, JD, president and chief executive officer of AIDS United, also commented on the bill, in a statement. He said: “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 polities like those proposed by Senator Harris’ PrEP legislation.”