HIV drug PrEP to be classified as preventive

Must be covered by health plans for 2021.

DENVER (June 12, 2019) – Recently, the U.S. Preventive Services Task Force (USPSTF) determined that the prescription drug Pre-Exposure Prophylaxis (PrEP) will be considered a preventive treatment for health benefit plans beginning in 2021. This means that such plans will be required to cover PrEP without co-payment, coinsurance or deductibles from plan enrollees.

PrEP is a highly effective drug in preventing HIV transmission, and is recommended for anyone at risk of contracting HIV. Truvada is the brand name for PrEP, but a generic version of it is expected in 2020, which should decrease the drug’s costs.

“We commend the USPSTF for adding PrEP to the list of covered preventive treatments,” said Insurance Commissioner Michael Conway. “This puts a highly effective medication within reach of those who need it, and it will save lives.”

"We applaud all efforts to make PrEP more accessible to those at high risk of becoming infected with HIV,” offered Daniel Ramos, Executive Director of One Colorado. “With only 20 percent of LGBTQ Coloradans being offered PrEP by their medical provider, we have a lot more work to do. We are excited to get to work with partners like the Colorado Division of Insurance to improve coverage, remove out-of-pocket costs, and prevent new HIV infections.”

The DOI will work with insurance carriers, consumer groups and other stakeholders this year and into 2020 to develop regulations around this determination so that it will be reflected in the health benefit plans for 2021 that will need to be filed with the Division in the summer of 2020.

The U.S. Preventive Services Task Force is an independent, volunteer panel of national experts in disease prevention and evidence-based medicine that makes recommendations about clinical preventive services.The USPSTF determines which procedures and medications are considered preventive by grading them. Per the ACA, any preventive measures graded “A” or “B” must be covered by health benefit plans and must not require payment from plan enrollees.

In November 2018, the USPSTF issued a draft recommendation to include PrEP for an “A” grade, and that recommendation was finalized earlier this month.

For more about Colorado PrEP providers, financial assistance, materials and other information, visit the Colorado Department of Public Health and Environment’s site “Services for people at risk for HIV.” Information about HIV in Colorado can be found in the Department’s May 2019 “HIV Epidemiology Annual Report.”

###

The Colorado Division of Insurance (DOI), part of the Department of Regulatory Agencies (DORA) regulates the insurance industry and assists consumers and other stakeholders with insurance issues.  Visit dora.colorado.gov/insurance for more information or call 303-894-7499 / toll free 800-930-3745

DORA is dedicated to preserving the integrity of the marketplace and is committed to promoting a fair and competitive business environment in Colorado. Consumer protection is our mission. Visit dora.colorado.gov for more information or call 303-894-7855 / toll free 1-800-886-7675


Media Contact:
Vincent Plymell
Division of Insurance
vincent.plymell@state.co.us 
p: 303-894-2261 | c: 303-910-9614