Source: CDC LINK
Over 30,000 in the US are infected with HIV each year. Effective antiretroviral drug therapy means that many can now lead long lives with relatively good health, but treatment for HIV has risks, adverse effects, and is expensive. Preventing HIV infection is better, and we have effective preventive tools. There are currently three brand name medications and one generic medication approved for HIV prevention (pre-exposure prophylaxis, or PrEP) in high-risk patients, and they are woefully underused. One of the brand name HIV medications, Descovy, was not tested on women, and is not yet approved for use in women. The federal government announced a plan last year to reduce new HIV infections by 90% by 2030. This plan includes increasing use of PrEP.
Although two thirds of new cases of HIV are in men who have sex with men, almost a quarter of new cases are in heterosexuals. KFF Health News and National Public Radio reported last week about at-risk Black women, who often do not receive PrEP treatment. Black women are 13% of the female population, but represent over half (54%) of all new HIV infections in women. Among Black women (and women of all races) with newly diagnosed HIV, the most common risk factor was heterosexual contact. Women represented 6% of those prescribed oral PrEP (2022) and 19% of new cases of HIV (2021).
Implications for employers:
The Affordable Care Act (ACA) requires coverage of PrEP without cost sharing, including for related office visits and testing. A federal court has stated that religious employers do not have to comply with this,and found some ACA preventive care requirements unconstitutional. On May 15, 2023 the 5th Circuit Court of Appeals issued an administrative stay of the district court’s ruling in this matter. This means that federal government can continue enforcing the preventive services requirement while the 5th Circuit considers the government’s motion for a stay pending appeal. The 5th Circuit’s stay of the trial court ruling will allow the USPSTF preventive service recommendations and related coverage requirements to remain in effect pending appeal.
Employers can check with their PBMs and medical carriers to be sure preventive care cost waivers are implemented appropriately.
Employers can improve access to PrEP through member education and coverage of telemedicine for related visits. There are some available vendors which provide virtual care to support PrEP.
Employers can ask their PBMs to report on use of HIV medications by gender. Each of the PrEP medications can be used for HIV treatment, and prescriptions do not include a diagnosis, so reporting may include some use of these medications for HIV treatment as opposed to prevention.
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