NASTAD Applauds U.S. Senator Kamala D. Harris Bill to Dramatically Expand Access to PrEP

By Amy Killelea June 26, 2019

This post is authored by Amy Killelea, Senior Director, Health Systems and Policy; Edwin Corbin-Gutiérrez, Senior Manager, Health Systems Integration; and Emily McCloskey, Director, Policy & Legislative Affairs

PrEP, or pre-exposure prophylaxis, is a medication that when taken daily reduces the risk of HIV infection by up to 92%. PrEP is an effective form of HIV prevention and a huge step toward ending new HIV infections. However, due to the high cost of the medication and other social factors, marginalized communities, such as gay and bisexual men, transgender women, and in particular, people of color, who would benefit from PrEP the most are not able to access this powerful prevention tool. Barely 20% of the more than a million people who are most vulnerable to HIV are receiving PrEP.  

On Thursday, June 20, 2019, U.S. Senator Kamala D. Harris introduced a sweeping bill that includes a number of non-discrimination and access protections for PrEP as well as new funding to make PrEP available to those who need it. Harris’ legislation requires that all private and public insurance plans, including Medicare and Medicaid, cover PrEP, associated doctors’ visits, tests, and monitoring recommended by the Centers for Disease Control and Prevention without cost sharing. The bill also bans discrimination based on use of PrEP in life and disability insurance and creates a national PrEP program, allowing public health and safety net providers to provide access to medication, clinical services, and labs associated with PrEP. 

“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. 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. We must truly commit ourselves to HIV prevention by finally requiring every health insurance plan—public and private—to cover PrEP and all of the required tests and follow-up doctors’ visits. We must also provide the resources necessary to help people without insurance access PrEP. Nearly four decades since the beginning of the HIV/AIDS crisis that took so many lives and caused countless others to live in fear, we can and will stop the spread of this disease,” said Senator Harris. 

The legislation by Senator Harris emphasizes the relevance of the work that NASTAD has done on PrEP financing. NASTAD has provided information on PrEP patient assistance programs (PAPs) and cost-sharing assistance programs (CAPs) to spread knowledge about payment assistance for individuals needing financial assistance to access PrEP. Furthermore, NASTAD created an online tool to aid providers and clients evaluate pricing and coverage for PrEP across health plans. This tool, PrEPcost.org, helps individuals choose the best plan for them, search for providers, and receive consumer assistance and enrollment support. The PrEP finance tools seek to demystify payment options and increase medication accessibility.  

In addition to PrEP financing, NASTAD has also long acknowledged that HIV-related stigma erodes our prevention efforts. NASTAD’s toolkit to address stigma in public health practice provides key information and recommendations to remove stigma and improve health outcomes for Black/African American and Latino gay men. Specifically, the toolkit acknowledges that PrEP could be a game-changer for disproportionately impacted communities, particularly those communities where PrEP is underutilized due to HIV stigma and medical mistrust. The toolkit also highlights steps to remove stigma, including increased education and awareness. The bill by Senator Harris addresses the difficulties of stigma and proposes similar strategies. 

NASTAD applauds Senator Harris’ new legislation and her dedication to ending the HIV epidemics. Coupled with efforts to bring down the cost of the drug, this bill would drastically improve access to PrEP and get us one step closer to our goals of reducing new infections.