Private insurers are now required to provide HIV prevention drugs (commonly referred to as pre-exposure prophylaxis or PrEP) to policyholders at no cost after a recommendation by the U.S. Preventative Task Force (“Task Force”).

Under the Affordable Care Act, insurers are required to provide certain preventative services at no cost if the Task Force assigns a service with an “A” or “B” rating. On June 11, 2020, the Task Force assigned PrEP with an “A” recommendation for individuals who are at high risk of HIV in the Journal of the American Medical Association. This means that individuals with employer-sponsored insurance will no longer need to pay any deductibles, co-pays, or co-insurance for PrEP medication.

The new coverage requirement will apply to plans that are renewed or issued after the Task Force’s recommendation (for the 2021 plan year). Although plans are not required to offer the coverage for free until their plans are renewed after June 11, 2020, California’s Insurance Commissioner released a notice that encouraged insurers to provide PrEP without cost-sharing as soon as possible.

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Emerald Law – Emerald is a Client Compliance Consultant for Sequoia, where she works with our clients to optimize and streamline benefits compliance. In her free time, Emerald enjoys stand-up comedy, live music and writing non-fiction.