Senate Bill Proposes Expansion of PrEP Access

A bill introduced by Senator Kamala Harris (D-CA) Thursday, the PrEP Access and Coverage Act, would expand access to pre-exposure prophylaxis (PrEP), medications that can reduce the risk of HIV infection by up to 92%.¹

A generic form of PrEP is expected to be released in 2020, but the high cost of the medication makes accessibility difficult for those in need of it—largely gay and bisexual men, transgender women, and people of color, according to a press release announcing the bill. Gilead's emtricitabine and tenofovir disoproxil fumarate therapy (Truvada), a PrEP medication, has a list price of over $20,000 per year, according to Harris.¹

If passed, the bill would:¹

• Require all public and private health insurance plans to cover the drug, required tests, and necessary follow-up visits without a copay.
• Fund a grant program to help states, territories, and tribal communities facilitate access to the medication for uninsured patients. The bill authorizes grants to cover the costs of the medication and support outreach to medical providers.
• Prohibit life insurance, disability insurance, and long-term care insurance companies from denying coverage or charging higher premiums to customers taking PrEP.
• Fund a public education campaign to inform the public about the safety and efficacy of the drug, in an effort to reduce disparities in access to and use of PrEP.

Earlier in June, the US Preventative Services Task Force (USPSTF) recommended requiring all public and private insurers to cover PrEP as part of their health plans by 2021, but their recommendation did not go so far as to ban those companies from charging a copay for the medication.²

J. Maurice McCants-Pearsall, Director of HIV & Health Equity at the HRC Foundation said that Harris' bill would help communities disproportionately impacted by HIV, particularly black and Latinx gay and bisexual men and transgender women. “Expanding access to PrEP is central to ending the HIV and AIDS epidemic,” McCants-Pearsall said, in a prepared statement. ¹

Concerns about the price of PrEP were being raised prior to the bill's introduction. In May, America’s Health Insurance Plans (AHIP) submitted a statement to the House Oversight and Reform Committee for a meeting on the excessive list price of emtricitabine and tenofovir disoproxil fumarate. The statement accused drug manufacturers of using the market for financial gain at the expense of patients.³

“Since its FDA approval in 2012 for HIV prevention, the average wholesale price of Truvada has increased by 45%,” the AHIP statement said.³ “Truvada is covered by most health insurance providers. However, with no generic version and no FDA-approved therapeutic alternative currently available, the rising price and cost of Truvada are limiting access to lifesaving medications for some of our country’s most vulnerable populations.”

In her own statement, Harris said accessibility to PrEP is a vital part of providing adequate health care.¹

“PrEP is a critical advancement in the fight against HIV that can finally provide peace of mind to Americans who live in the shadow of the HIV epidemic,” she said.¹ “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.”

References

• Harris Introduces Bill to Dramatically Expand Access to PrEP [news release]. Washington, DC; June 20, 2019: Kamala D. Harris. https://www.harris.senate.gov/news/press-releases/harris-introduces-bill-to-dramatically-expand-access-to-prep. Accessed July 21, 2019.
• Pharmacy Times. USPSTF Urges HIV PrEP for High-Risk Patients. Pharmacy Times website. https://www.pharmacytimes.com/resource-centers/hiv/uspstf-urges-hiv-prep-for-highrisk-patients. Published June 12, 2019. Accessed June 21, 2019.
• America's Health Insurance Plans. Statement for Hearing on “HIV Prevention Drug: Billions in Corporate Profits after Millions in Taxpayer Investments”. AHIP website. https://www.ahip.org/wp-content/uploads/oversight_hearing_hiv_prevention_drug_05_16_19.pdf. Published May 16, 2019. Accessed June 21, 2019.