Biden proposes new rule eliminating cost sharing for injectable PrEP

President Joe Biden's administration Monday proposed a new rule that would require private health plans to provide coverage of long-acting injectable pre-exposure prophylaxis drugs without cost-sharing. The proposed rule was contained within other proposals requiring health plan contraception coverage without cost sharing.

The proposed rule, which deals with enforcement of the Affordable Care Act, would require private health care plans “to cover every FDA-approved contraceptive drug or drug-led combination product without cost sharing unless the plan also covers a therapeutic equivalent without cost sharing,” the administration said in a press release.

Drug-led combination products are therapeutic or diagnostic products delivered by a medical device, such as a syringe.

“With low uptake of PrEP among the communities most impacted by HIV, this insurance coverage requirement with zero cost-sharing will help jump-start the use of more effective forms of PrEP and lead to fewer HIV transmissions," Carl Schmid, executive director of the HIV+ Hepatitis Policy Institute, said in a statement provided toThe Bay Area Reporter.

Schmid said the Biden administration responded to his group's “request to issue this guidance” on the issue of PrEP and drug-led combination therapy coverage.

“Without it, we feel some insurers would continue to only cover daily oral PrEP and not provide PrEP users with the choice they need,” Schmid said of the proposed rule, according to the Reporter. “With up to a third of privately insured PrEP users still being charged cost-sharing, we must ensure that both federal and state regulators vigorously enforce PrEP coverage requirements.”

While Biden did not directly address the coverage of PrEP in his statement, he called out Republicans for working to limit family planning services to women, most notably in the recent U.S. Supreme Court ruling overturning Roe v. Wade.

“At a time when contraception access is under attack, Vice President Harris and I are resolute in our commitment to expanding access to quality, affordable contraception,” Biden said in the press release. “We believe that women in every state must have the freedom to make deeply personal health care decisions, including the right to decide if and when to start or grow their family. We will continue to fight to protect access to reproductive health care and call on Congress to restore reproductive freedom and safeguard the right to contraception once and for all.”