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ACA: Most insurers cover HIV-prevention drugs without a deductible | life

Harrisburg, Pennsylvania – After World AIDS Day, the Pennsylvania Insurance Department wants to remind the public of an HIV prevention drug that is available from most insurers.

PrEP is the abbreviation for HIV pre-exposure prophylaxis. These drugs prevent the spread of HIV by preventing the virus from replicating in the body. The drug is highly recommended for those who may have a sexual partner with HIV or who are using injectable medications.

Under the Affordable Care Act, the federal government requires most insurers to cover PrEP with no co-payment, deductible, or co-insurance. In addition, testing, doctor visits, and other services directly related to receiving PrEP must be covered without out-of-pocket expenses.

A September 2022 federal court case found that some companies and insurance providers may be excluded from PrEP coverage on religious grounds. Individuals who received HIV PrEP medication and were billed for a copay, co-insurance, or deductible can still contact their health plan to request a refund. Otherwise, if you don’t have insurance or your insurance doesn’t cover PrEP, you may be eligible for assistance.

Coverage requirements include brand names such as Truvada and Descovy. Insurers may require prior approval to confirm that a particular branded drug is medically necessary before qualifying for free coverage.

“To end the HIV epidemic in Pennsylvania and the United States, we must work together to raise awareness, reduce stigma, and increase access to life-saving drugs like PrEP,” said Dr. Katharine Dalke, Commissioner for the Pennsylvania Commission on LGBTQ Affairs. “Fortunately in our state, PrEP is insured and available to patients who need it.”

Those who are uninsured are advised to explore coverage options through the Pennie, Pennsylvania Official Online Health Insurance Marketplace. Registration is open now and will remain open until January 15, 2023. December 15 is the deadline to obtain insurance coverage, which begins January 1, 2023. Otherwise, the insurance cover begins on February 1st.

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