Democratic presidential candidate Sen. Kamala Harris (D-Calif.) introduced a bill on Thursday that would make a highly effective but underused anti-HIV drug more accessible, tackling both its cost and the stigma it carries.
Harris’ bill focuses on expanding access to pre-exposure prophylaxis, or PrEP, a medication that dramatically lowers the risk of contracting HIV for people at high risk for the infection. The bill would ease the financial burden on consumers by guaranteeing the pill is fully covered by private insurance, Medicaid and Medicare and would allocate resources to cover uninsured patients. It would also ban companies selling life, disability and long-term insurance from denying coverage or charging higher premiums to people taking PrEP.
The bill would also address the stigma associated with PrEP by funding a public education campaign on the pill, highlighting its effectiveness and safety.
“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,” Harris said in a statement. “But for too many in our country, lack of insurance coverage and exorbitant costs have put PrEP out of reach ― and that needs to change.”
PrEP is highly effective. Consistent use of PrEP by people at high risk for HIV has been shown to reduce their risk of contracting the disease by up to 92%, according to the Centers for Disease Control and Prevention.
But it can be prohibitively expensive. A 30-day supply of Truvada, a brand-name PrEP pill, costs $2,000 ― a price that has risen in the last few years. In 2018, Truvada cost over $20,000 per year. And while most insurers do cover the pill, they don’t cover it all the way.
HIV is sometimes more prevalent in communities with less health care, according to Trevor Hart, director of the HIV Prevention Lab and a professor in the Department of Psychology at Ryerson University in Toronto.
Harris’ bill would “equal the playing field,” Hart said. “And, [it] hopefully would allow people who are lower income to have better access to the medication.”
PrEP use among gay and bisexual men who are at risk of HIV infection has risen in the past few years: It surged from only 6% in 2014 to 35% in 2017, according to a CDC study presented in 2019. Some 90% of the 8,000 men interviewed for the study knew about PrEP, with awareness almost 10% higher among white men than African American and Latino men. (The study focused on gay and bisexual men, although PrEP can also be taken by anyone who is at high risk of HIV.)
Put simply, more people know about the highly effective pill than are choosing to take it. The pill is underutilized, the study concluded.
And its use is marked by a stark racial divide: While 42% of white gay and bisexual men use PrEP, just 26% of African American men do.
Private insurance companies will already be required to cover PrEP beginning in January 2021 after the United States Preventive Services Task Force ― an independent volunteer organization of physicians ― gave the drug a Grade A ranking earlier this month. The rating requires private insurance plans to cover PrEP entirely for at-risk populations.
Harris’ bill expands on this recommendation, guaranteeing that all insurance plans ― private and public, including Medicare and Medicaid ― will cover PrEP and all related doctors’ visits and tests.
PrEP is similar to a vaccine, since it’s preventive intervention, said Dr. Daniel Havlichek, professor of medicine and chief of the College of Human Medicine Infectious Diseases Division at Michigan State University.
“We would not prevent an influenza vaccine or pneumococcal vaccine or measles, mumps, rubella vaccine to people who were indigent or uninsured just because they didn’t have money,” said Havlichek, who specializes in infectious diseases including HIV.
He said the bill is a “really good idea.”
The bill’s focus on the stigma associated with the drug as well is especially important, according to Ann Bagchi, an assistant professor in the Division of Nursing Science at Rutgers who studies health care services for people with HIV and AIDS.
“Just because someone has access to care doesn’t mean they’re going to use it,” she said.
If the bill is passed, the United States will “be following in the footsteps of other countries and other jurisdictions that have successfully used this policy,” Hart said. Over half a dozen provinces in Canada, where he lives, cover PrEP, including Quebec.
Lambda Legal, a national LGBTQ civil rights nonprofit organization that was consulted by Harris’ team while they were creating the bill, expressed support for the bill.
“Lambda Legal is thrilled to support this bill, which will not only make PrEP accessible to thousands upon thousands of people at higher risk for HIV, but will also ensure that life, disability and long-term care insurance companies stop discriminating against PrEP users merely for taking appropriate measures to protect their health,” Scott Schoettes, HIV project director at Lambda Legal, said in an email. “We are hopeful that a common sense measure like this ― one that will save the government millions of dollars over time ― will fly through Congress!”
CORRECTION: This article previously included comment from an expert suggesting that Harris’ bill would be more effective by giving health care providers additional resources. The bill does in fact allocate funds for outreach to physicians and providers for education on PrEP and recommends best practices for clinical care, and in light of that, the comment has been removed.