![]() ![]() If your employer doesn't, you can ask if it would consider it. Contact your human resources department to find out. Some of those insurers may cover the drug anyway. Most insurance offered through employers will also have to cover Truvada for PrEP, with one exception, according to CMS: if your employer is "self-insured," meaning it pays all its own medical bills, and was "grandfathered," meaning that it got an exception in 2009 when the ACA was passed. ( See whether your state expanded Medicaid.) In the 39 states (and Washington, D.C.) that expanded Medicaid in recent years to allow people with higher incomes to enroll, Medicaid will have to cover the full cost of Truvada for PrEP, with no copays or coinsurance. ![]() The new CMS mandate applies to Affordable Care Act plans that individuals purchase on their own through state or federal marketplaces, as well as most Medicaid plans. Walensky-then chief of infectious diseases at Massachusetts General Hospital and now director of the Centers for Disease Control and Prevention-wrote an editorial in the Journal of the American Medical Association saying that insurers should cover the drugs for free, noting that federal law requires many insurers to cover any preventive measure that earns a high rating from the task force. (Descovy wasn't available in time for that analysis.)Īt that same time, Rochelle P. Preventive Services Task Force-an independent group that helps the government review medical research on drugs and other treatments-concluded that the benefits of Truvada vastly outweighed its risks, giving the drug an A rating. distrustful of government-funded research related to HIV prevention and treatment, he says, and even of programs designed to make the drugs more affordable. That experience still makes many Black men in the U.S. ![]() "There are communities in and around metro Atlanta where people have family members or friends who were impacted by the Tuskegee experiments." ![]() "You can't talk about HIV and other sexual health disparities and not have conversations about that experiment", Barrington-Ward says. Some of that distrust traces back almost 90 years to an infamous government-funded study in which Black men with syphilis were told that they were being treated for "bad blood," but didn't receive care for about for 40 years. "There are 1.6 million Georgians, for example, who don't have health insurance, many of whom are Black men or people of color, who are not getting access to regular checkups and preventative treatment, much less having conversations about their sexual practices," he says.Īnother reason is a deep distrust of the medical system among some African Americans, especially in the South and especially related to sexual health, Barrington-Ward says. One reason for the low number of Black people taking Truvada or Descovy for PrEP is that many of them live in states, mainly in the South, that haven't expanded their Medicaid programs, Barrington-Ward says. "A significant component of ending the HIV epidemic," she says, "is ensuring that in addition to medication coverage, communities most at risk for HIV and those with the greatest need have access to care that is free from stigma, and delivered by providers who understand the experiences of the community." That's especially true for African Americans and Hispanics, who are much more likely than whites to be diagnosed with HIV but much less likely to talk with a healthcare provider about the drugs, says Devin Barrington-Ward, founder of the Black Futurists Group, a social justice organization in Atlanta.Ĭhu hopes that making the drugs more affordable may remove some of those barriers. Still, experts worry that some people who could benefit from the drugs may continue to go without. There's also good news for people who don't have insurance or whose insurance still won't cover the drugs: There's now a generic form of Truvada, which is just as effective and safe as the brand-name version and can be found for about $40 a month. The step is a welcome development for HIV prevention efforts, says Carolyn Chu, MD, chief medical officer at the American Academy of HIV Medicine, because the number of people currently getting PreP is "lower than what many providers, public health organizations, and advocacy organizations have hoped for." And under provisions established by the Affordable Care Act, insurers must make all preventative care available free to their members. The Biden administration's action is based on research showing that each drug is up to 99 percent effective at preventing HIV infection. ![]()
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