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A Reader Asks: Are Insurers Required To Cover HIV Prevention Medication Recently Recommended By CDC?

May 23, 2014

Q. Now that the federal Centers for Disease Control and Prevention recommends a daily pill to prevent infection with the virus that causes AIDS, will my insurer be required to cover the drug at no cost to me?

A. No, it won’t be required, not at this time. Earlier this month the CDC released new clinical guidelines recommending that people who are at substantial risk of becoming infected with HIV, the virus that causes AIDS, take a daily pill called Truvada. This "pre-exposure prophylaxis" approach can prevent HIV infection in more than 90 percent of cases. 

Although insurance typically covers the drug, it's expensive, with an annual price tag of at least $10,000, and that can mean high copayments for health plan members.

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Under the health law, most health plans are required to cover without any cost sharing those preventive services that are recommended by the U.S. Preventive Services Task Force.

The task force, a nonpartisan group of medical experts, analyzes the scientific evidence related to clinical preventive services and makes recommendations about their use.

At this time, the task force recommends HIV screening for people aged 15 to 65. It doesn't have a recommendation on preventive medications for HIV/AIDS, nor is any such review in the pipeline, according to a spokesperson for the task force. 

"The task force bases its recommendations on a thorough review of the current evidence. When making a recommendation, the task force considers the recommendations of other groups, including the CDC," the spokesperson said.

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