On July 19, 2021, the Departments of Labor, Health and Human Services (HHS), and the Treasury (collectively, the Departments) published a set of FAQs regarding the coverage of HIV Preexposure Prophylaxis (PrEP) as preventive care.
Background
The ACA requires non-grandfathered insurers and health plans to cover preventive care at 100% without cost sharing. It defines preventive care, in part, as those services that are rated “A” or “B” in the current recommendations of the United States Preventive Services Task Force (USPSTF).
In 2019, the USPSTF issued a recommendation that clinicians offer PrEP with “effective antiretroviral therapy to persons who are at high risk of human immunodeficiency virus (HIV) acquisition.” The recommendation came with a set of protocols including baseline and monitoring services, including:
The FAQs
According to the FAQs, it appeared that many plans and insurers failed to understand that the coverage requirements applied to those testing and counseling services as well as the PReP medication itself.
The FAQs give plans and issuers 60 days from the date of publication to conform coverage to these requirements.
Click here for a copy of the FAQ.
