Group Health Plans Required to Cover Cost of HIV-Preventive Drug, Truvada

Effective January 1, 2021, and with the exception of ACA-compliant Grandfathered Plans, most group health plans and insurance issuers must now cover the full cost of Truvada, an HIV-preventive preexposure prophylaxis (PrEP) drug. PrEP drugs are recommended for use by persons at high risk of HIV infection, including injection drug users and men who engage in sexual activity with men. Truvada was awarded an “A recommendation by the U.S. Preventive Services Task Force; under the ACA, preventive services receiving an “A” or “B” rating by this force must be covered by most private plans without participant cost sharing.

Other drugs in the coverage category include Descovy and a generic version of Truvada. Be aware, however, that coverage is for prevention only, and both Truvada and Descovy are used as treatment for those already diagnosed with HIV. Also note that necessary physician visits and lab tests to secure prescription of the PrEP by prospective patients is not yet fully-covered as a preventive service. Last, only persons covered by private health insurance plans are eligible for full-coverage cost of the PrEP; however, makers of such drugs offer patient assistance programs for the uninsured.

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