Medications, services, and testing should be covered—or free—under almost all insurance plans.
The Affordable Care Act (ACA) requires most plans to cover PrEP and associated clinic and lab visits, with no out-of-pocket cost.
Many global and national organizations recommend discussing PrEP for HIV prevention
Federal, primary care, reproductive, pediatric, and infectious disease organizations endorse discussing PrEP for HIV prevention1-9
USPSTF
US Preventive Services Task Force
ACHA
American College Health Association
CDC
Centers for Disease Control and Prevention
AAP
American Academy of Pediatrics
DHHS
US Department of Health and Human Services
IAS—USA
International Antiviral Society—USA
ACOG
American College of Obstetricians and Gynecologists
WHO
World Health Organization
Resources available to help individuals access PrEP
PrEP is covered by law12,13
Those without insurance can still access PrEP13
If individuals in your practice do not have insurance, there are many different state, patient advocate organization, health center, and manufacturer access programs to help them afford PrEP.
References:
1. US Preventive Services Task Force; Owens DK, Davidson KW, Krist AH, et al. Preexposure prophylaxis for the prevention of HIV infection: US Preventive Services Task Force recommendation statement. JAMA. 2019;321(22):2203-2213.
2. Centers for Disease Control and Prevention. US Public Health Service: Preexposure prophylaxis for the prevention of HIV infection in the United States—2021 Update: a clinical practice guideline. Accessed September 12, 2024. https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2021.pdf
3. National HIV/AIDS strategy for the United States 2022-2025. The White House. 2021. Accessed September 12, 2024. https://www.whitehouse.gov/wp-content/uploads/2021/11/National-HIV-AIDS-Strategy.pdf
4. Centers for Disease Control and Prevention. HIV prevention in the United States: mobilizing to end the epidemic. Published October 2021. Accessed September 12, 2024. https://www.cdc.gov/hiv/pdf/policies/cdc-hiv-prevention-bluebook.pdf
5. Mmeje O, Zaritsky E, Coleman JS. Preexposure prophylaxis for the prevention of human immunodeficiency virus. The American College of Obstetricians and Gynecologists (ACOG). Published June 2022. Updated May 2024. Accessed September 12, 2024. https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2022/06/preexposure-prophylaxis-for-the-prevention-of-human-immunodeficiency-virus
6. ACHA Guidelines: HIV pre-exposure prophylaxis. American College Health Association (ACHA). Published January 1, 2019. Accessed September 12, 2024. https://www.acha.org/resource/hiv-pre-exposure-prophylaxis/
7. Hosek S, Henry-Reid L. PrEP and adolescents: the role of providers in ending the AIDS epidemic. Pediatrics. 2020;145(1):e20191743.
8. Gandhi RT, Bedimo R, Hoy JF, et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2022 recommendations of the International Antiviral Society—USA Panel. JAMA. 2023;329(1):63-84.
9. Global HIV Programme: Pre-exposure prophylaxis (PrEP). World Health Organization. Accessed September 12, 2024. https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hiv/prevention/pre-exposure-prophylaxis
10. US Preventive Services Task Force; Davidson KW, Berry MJ, Manigone CM, et al. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA. 2021;325(19):1965-1977.
11. US Preventive Services Task Force; Krist AH, Davidson KW, Manigone CM, et al. Screening for hypertension in adults: US Preventive Services Task Force reaffirmation recommendation statement. JAMA. 2021;325(16):1650-1656.
12. Nicoletti B; HIV Medicine Association. Billing Coding Guide for HIV Prevention. National Alliance of State and Territorial AIDS Directors (NASTAD). Published April 2016. Accessed September 12, 2024. https://nastad.org/sites/default/files/2021-12/PDF_BillingCodingGuide_v5.pdf
13. Centers for Disease Control and Prevention. HIV Nexus: CDC resources for clinicians. Updated August 20, 2024. Accessed September 4, 2024. https://www.cdc.gov/hivnexus/hcp/prep/index.html