07.17.19

Schiff, Watson Coleman Introduce PrEP Access and Coverage Act

Legislation Would Expand Access to and Insurance Coverage of the HIV Prevention Drug & Treatment-Related Services

WASHINGTON, D.C. – Today, Reps. Adam Schiff (D-CA) and Bonnie Watson Coleman (D-NJ) introduced the PrEP Access and Coverage Act to expand access to and insurance coverage of Pre-Exposure Prophylaxis (PrEP), the proven HIV prevention drug. The bill would create a grant program to fund uninsured patients’ access to this critical medication, and would cover services related to treatment. Senator Kamala Harris (D-CA) introduced the companion legislation in the Senate.

“The advent of PrEP, a drug which dramatically reduces the risk of HIV infection, has made the disease more preventable and manageable than ever before. But this life-saving drug is tragically under-utilized by the communities who need it most, in part because health insurance plans aren’t required to cover PrEP, or its necessary tests and follow-up visits,” said Rep. Schiff. “No American should contract and suffer from HIV simply because they cannot afford preventative medicine. I urge my colleagues to support this bill to expand access to PrEP. We have the medical resources to end the HIV epidemic – now we must ensure that every American, regardless of their income or identity, can access them.”

“We have a tool that can prevent the transmission of HIV, yet it’s not reaching, or is too expensive for, the communities who need it most. African Americans represent 14% of the US population but account for 44% of HIV diagnoses, while Latinos represent 18% of the US population and 25% of HIV diagnoses – yet they are often unaware of that heightened risk, are more likely to be uninsured, and are less likely to even know that PrEP could help them,” said Rep. Watson Coleman. “This bill addresses those issues to improve access and usage, while also ensuring that those who protect themselves with PrEP don’t experience discrimination for doing so.”

“For too many in our country, lack of insurance coverage and steep costs have put PrEP out of reach. That needs to change,” said Senator Harris. “I’m so proud to work with Congressman Schiff and Congresswoman Watson Coleman on this legislation to finally require every health insurance plan—public and private—to cover PrEP and all of the required tests and follow-up doctors’ visits. The bill would 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.”

Approximately 1.1 million people in the United States are currently living with HIV, and in 2017, there were 38,281 new HIV diagnoses. HIV disproportionately impacts gay and bisexual men, transgender women, and, in particular, people of color. Members of communities at the intersections of these groups are most heavily impacted. When taken daily, PrEP reduces the risk of HIV infection by up to 92%.

Specifically the bill would:

  • Require all public and private health insurance plans to cover the drug—as well as all required tests and follow-up visits—without a copay, just as the Affordable Care Act requires insurance to cover contraception and other preventive services.
  • Fund a grant program to assist states, territories, and tribal communities in facilitating access to PrEP for people who lack insurance. The bill authorizes grants to cover the cost of the drug, as well as all associated tests and follow-up visits. The grants will also support outreach to physicians and other providers designed to increase understanding of PrEP and the recommended clinical practices for providing care.
  • Prohibit companies selling life insurance, disability insurance, and long-term care insurance from denying coverage or charging higher premiums to people who take PrEP.
  • Fund a public education campaign to reduce disparities in access to and use of PrEP by educating the public—particularly high-need communities in which PrEP is underutilized—about the safety and efficacy of the drug and to combat stigma associated with using PrEP.

“The PrEP Access and Coverage Act is a bold step towards ending the HIV epidemic once and for all. It will help to ensure that PrEP – a crucial tool in fighting HIV and AIDS – can be accessed by the communities that need it most. Because of lack of awareness, inability to access culturally competent health care and associated costs, very few people take PrEP, particularly those at highest risk of infection: gay/bi men of color, trans women, youth and women of color,” said  Lorri L. Jean, CEO of the LA LGBT Center. “This Act would go a long way towards ending these disparities. It’s good for the public health and it makes enormous financial sense. It’s a lot cheaper to prevent the spread of HIV than it is to treat people with HIV. We applaud Congressman Schiff for his foresighted leadership.”

“Expanding access to PrEP is central to ending the HIV and AIDS epidemic,” said J. Maurice McCants-Pearsall, Director of HIV & Health Equity at the HRC Foundation. “Representative Schiff's bill helps ensure that communities disproportionately impacted by HIV, particularly Black and Latinx gay and bisexual men and transgender women, are guaranteed insurance coverage for life-saving preventive interventions and the requisite follow-up and monitoring, while also expanding access for those who are uninsured. We thank Representative Schiff for sponsoring this lifesaving and innovative legislation.”   

“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.  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!” said Scott Shoettes, HIV Project Director, Lambda Legal.

Background information on the bill is available here. The full text of the bill is available here.

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