The Biden administration has put up a ground-breaking plan to increase Americans 65 and older’s access to pre-exposure prophylaxis (PrEP) medications, marking a major advancement in the fight against the HIV epidemic.
The proposal, if enacted, would see Medicare covering the entire cost of PrEP medications, marking a pivotal moment in the nation’s efforts to reduce the risk of HIV infection.
The proposed policy, revealed by the Centers for Medicare & Medicaid Services (CMS), encompasses both oral and injectable PrEP medications for individuals deemed at high risk of HIV infection.
Physicians would be crucial in identifying patients with an elevated risk, ensuring targeted intervention strategies. Additionally, the proposal includes coverage for up to seven counseling visits annually, HIV risk assessments, and regular screenings to monitor medication adherence.
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Current Landscape of HIV Infections
According to the National Institutes of Health, nearly half of all Americans living with HIV are 50 years of age or older. While many contracted the virus in their youth, advancements in treatment have allowed them to live for decades. Basketball legend Earvin “Magic” Johnson, who disclosed his HIV status in 1991, stands as a prominent example, now at 64 years old.
PrEP medications have demonstrated remarkable effectiveness, reducing the risk of HIV infection through sexual transmission by 99%, as reported by the Centers for Disease Control and Prevention (CDC).
Moreover, the drugs reduce the risk of contracting HIV through injection drug use by 74%. Despite these promising statistics, a significant portion of Americans eligible for PrEP drugs are not receiving them.
One major impediment to broader PrEP adoption is the cost. A survey conducted by Johns Hopkins revealed that, even with insurance coverage, patients could face annual co-pays exceeding $2,000, deterring many from obtaining the medication. Concerns about potential side effects were also identified as a barrier.
The proposed Medicare policy seeks to address existing disparities in PrEP access. According to CDC figures, in 2022, only 14.5% of eligible women were prescribed PrEP drugs compared to 41% of eligible men.
Racial disparities were even more pronounced, with 94% of eligible white patients receiving prescriptions, while only 12.8% of eligible Black patients and 24.4% of eligible Hispanic patients obtained the drugs.
The inclusion of injectable PrEP in the proposed policy is particularly noteworthy. The first injectable PrEP, Apretude, received FDA approval in late 2021 and became available in 2022. Leisha McKinley-Beach, CEO of the Black Public Health Academy, emphasized that this development could significantly benefit women who find it challenging to adhere to a daily pill regimen.
With an estimated 1.2 million Americans currently living with HIV, the Biden administration’s initiative aligns with its Ending the HIV Epidemic in the US goal.
The federal government aims to reduce new HIV infections by 75% by 2025 and 90% by 2030. Advocates assert that expanding access to PrEP medications is critical to achieving these ambitious targets, fostering a healthier and more resilient society.
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