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Medicine Government United States

US Insurers Are Still Charging for HIV Prevention Pills That Should Be Free (msn.com) 144

The Washington Post reports on tens of thousands of Americans "forced to pay for medication" to prevent the HIV infections, "despite federal requirements guaranteeing free access to treatment...according to multiple studies and interviews with medical professionals, activists and patients." Insurance companies are skirting rules compelling them to pay for pre-exposure prophylaxis treatment, known as PrEP, researchers and HIV advocacy organizations say — leaving patients to shell out hundreds of dollars each year for medication co-pays, doctor visits and screenings required to stay on drugs that reduce the risk of contracting HIV through sex by 99 percent.

Under the Affordable Care Act, commercial insurers must cover certain preventive health services. This is supposed to include at least one form of oral PrEP and related health services, such as regular testing for HIV and other sexually transmitted diseases, for people at increased risk of contracting HIV, according to 2021 guidance from the Biden administration. Responding to complaints that patients were still being charged, the Biden administration in October released new guidance instructing private insurers to cover all forms of PrEP without prior authorization, including new long-acting injections.

Nearly a third of a national sample of 325 health coverage plans on government insurance marketplaces did not include PrEP on their lists of covered preventive services, according to the AIDS Institute, a New York-based nonprofit. Between 20 and 30 percent of PrEP users with commercial insurance still had to pay for it despite the coverage mandate, with an average cost of $227 for 2022, according to the Centers for Disease Control and Prevention. Government regulators have been slow to crack down on insurer violations, activists say, creating a barrier to getting more at-risk Americans on the medication. The CDC estimates that only a third of the more than 1 million people who could benefit from PrEP have received a prescription, according to its most recent data.

The issue appears to be lax enforcement against insurers who break rules, a policy advocate told the newspaper. America's Centers for Medicare and Medicaid Services, which enforces regulations for preventive care, "said it takes enforcement seriously and recently found two insurance plans in violation of coverage requirements following consumer complaints."

And the Post spoke to an official at America's Labor Department, who said they were investigating a complaint against a large insurance company, but "said the agency does not have enough staff to conduct proactive investigations and lacks the authority to sue and penalize insurers that break the rules."

US Insurers Are Still Charging for HIV Prevention Pills That Should Be Free

Comments Filter:
  • by Joe_Dragon ( 2206452 ) on Saturday November 30, 2024 @01:39PM (#64981561)

    for profit healthcare needs to go!

    • Re: (Score:3, Insightful)

      by backslashdot ( 95548 )

      Every type of healthcare is "for profit" healthcare, ESPECIALLY when it's run and administered by politicians.

    • by shanen ( 462549 )

      Hey, it's a living!

      Joking aside, the problem is that profit becomes the primary motivation and the highest priority. Many medical problems have real solutions, but the problem of needing a bigger profit can NEVER be solved.

    • for profit healthcare needs to go!

      The rallying cry of sportsball/go-fast-thing fans everywhere.

      Imagine if we spent the equivalent of a year's worth of entertainment on STEM - keeping all the discoveries and advancements in the public domain.....

      HAHAHAHA. Will never happen. We *far* perfer whining and moaning to a little discomfort.

  • US Insurers Are Still Charging for HIV Prevention Pills That Should Be Free.

    Welcome to capitalism.

    • Yep. If I had HIV I'd want it treated by communists!
    • Re:Yay!! (Score:4, Informative)

      by VeryFluffyBunny ( 5037285 ) on Saturday November 30, 2024 @05:36PM (#64982013)
      Capitalism per se isn't bad. It's the inappropriate application of capitalism to sectors of economies that does the harm we see today. The USA promotes capitalism as theist dogma, i.e. not that it's sometimes useful in certain cases but that it's the only economic model that anyone should ever use... except for when corporations need government help, of course! e.g. bank bailouts, stimulus packages, tax breaks, offshore tax avoidance schemes, & shielding from prosecution.

      In this example, the healthcare corporations are being shielded from prosecution because they've fraudulently charged their customers for services the law says must be provided free of charge. This is usually referred to as "light touch regulation," which roughly translates into "letting them get away with it" in our language.

      When you let corporations essentially pay for your electoral system, as the saying goes, "He who pays the piper calls the tune." Welcome to Corporatocracy.
  • by rsilvergun ( 571051 ) on Saturday November 30, 2024 @01:53PM (#64981591)
    Most likely at least. There's a microscopic chance that The repeal will die in the house but it's unlikely because the insurance companies can threaten primary election challengers to anyone who breaks ranks on the Republican side. It doesn't matter if you lose your seat in the general election if you're just going to lose it in the primary after all...

    With the affordable Care act go on stuff like this isn't going to be long the world. Just like a whole bunch of people who voted for people who are going to repeal the bill that pays for their medicine...

    The leopards are going to eat very very well or at least the next 4 years.
  • too bad punishing thieves isn't going to be an american priority... look who you hired for the job, and he's putting together a little thing called The Revenge of the Old Boys. Just like his golf holdings, this is another club you won't be allowed into.
  • just get the drugs in canada

  • it's pretty weird from both medical and social pov that prep is even approved let alone covered like this.

    it's somewhat like taking antibiotics every day to prevent syphilis. This includes the resultant creation of multi drug resistant strains of HIV.

    The whole thing is is a Faustian bargain even separately from who bears the direct financial costs.

    • by backslashdot ( 95548 ) on Saturday November 30, 2024 @03:26PM (#64981767)

      The alternative is that people won't change their behavior, they'll get AIDS and die. Not that you'd care, but some (hopefully most) of us give a shit about human life even after it's out of a womb.

      Do you have any plan for how to get people to stop having sex? Not everyone is cutout for monogamy, joining a monastery, or becoming a slashdot troll.

      It's hard enough to get people to take PrEP. Second there's no evidence PrEP would cause super-bugs worse than a person getting AIDS and then having to go on the same drugs as whats in PrEP. The more copies of a virus in a person, the higher the probability a resistance evading virus will appear. In other words, taking anti-HIV medication after you've got a full blown infection is more likely to cause a super bug than taking the drugs as a prevention. Also, there are only a few anti-HIV drugs in the repertoire so if PrEP resistance emerges there are still treatment options.

      • by rta ( 559125 )

        Not everyone is cutout for monogamy, joining a monastery, or becoming a slashdot troll.

        there's also, you know ... condoms.

        Also, a LOT of human society is about individuals learning to moderate our animal tendencies, often with both carrots and sticks from our culture / society. Anger, lying , cheating , stealing, beating people up , overeating, etc etc. Het guys (and girls) don't exactly get to engage in consequence free unfettered sexual expression either...

        It's hard enough to get people to take PrEP. ...

        ok ok. "Faustian bargain" is perhaps too strong... let's say "double edged sword".

        moral hazard, risk compensation, etc.
        e.g.

    • by ToasterMonkey ( 467067 ) on Saturday November 30, 2024 @04:20PM (#64981839) Homepage

      It's no different than malaria prevention, to eradicate the disease. The medical and social reasons for doing this are obvious, unless you're dumb or hate people. Don't keep us guessing...

      • by rta ( 559125 )

        It's not that simple. PrEP for malaria would mean just having everyone in risky areas take antibiotics all the time. This is not something that's done because it would quickly result in resistant malaria. (this, in fact already happened back in the early 1900s w/ quinine, apparently (https://pmc.ncbi.nlm.nih.gov/articles/PMC3866000/ ) )

        Drug resistance is a big threat ( https://www.cdc.gov/antimicrob... [cdc.gov] )

        One reason PrEP is even entertained in HIV is because we don't have a cure for it anyway if someone get

        • Dude. You're mixing a few concepts here. Firstly malaria is not a microbe and has nothing to do with antibiotics. It's a group of parasites and the correct treatment is an anti-parasitic. This is important since parasites are vastly slower at adapting on an evolutionary scale than microbes which is precisely why people are far more concerned about the use of antibiotics than anti-parasitics (the latter of which you can buy at virtually every pet store - remember chloroquine?).

          Secondly prophylaxis does not c

          • by rta ( 559125 )

            Sorry, you're right i got my pathogens mixed up for malaria.

            On the HIV side the resistance concern is related to various forms of non-adherence such that infection happens while the patient has less than effective levels of the drug in their system and that's where the selection pressure comes in.

            e.g. this is about a "long acting" injectable that has a surprisingly long half-life, but some similar concerns with intermittent use of the pills as well ( though apparently that's less of a concern since it does

      • Yes it is, because there are another mean to avoid HIV that works excellent, condoms. And adults pay for that themselves. There are no condoms you can use to not get malaria. There are no excuses to get HIV today, as opposed to malaria (well, yeah, if you get raped or get HIV from a blood transfusion but that basically never happens). If you get HIV it is completely your own fault and responsibility. The culture in the gay community is completely stupid. If you think Trump is a moron, the gay community is o

  • Don't worry ... (Score:3, Insightful)

    by fahrbot-bot ( 874524 ) on Saturday November 30, 2024 @03:14PM (#64981753)

    US Insurers Are Still Charging for HIV Prevention Pills That Should Be Free

    I'm sure they won't be "should be free" sometime after Jan 20th 2025 ...

    (Double checking Project 2025 and Republican ACA agendas ... yup.)

  • Dude, I spend over $200/yr just on multivitamins.

    These are just beggars who want to live a lascivious lifestyle without cost or consequences.

    What's next, taxpayer-funded meth and GBA for support of their sexual expression? What kind of tyanny would suppress that by making them pay?

    I can't believe there are real people who think $200/yr to prevent AIDS is a bad deal. Here's another preventative method: monogamy. You even get tax discount.

    If we're talking about severely impoverished people, OK, that's a diff

    • Here's another preventative method: monogamy. You even get tax discount.

      Hell, if we didn't have an economy which was dependent on people constantly popping out more kids, I'd be all for creating a tax credit for abstinence.

    • by rta ( 559125 )

      Huh. On my first read i thought it was $200/mo.. but you're right in that it's $200/yr, but the source it links says that's for ancillary stuff: office visits and some blood testing. That link doesn't even mention the cost of (or co-pays for) the drugs themselves.

      So the whole argument of the article is about $200/yr on something that (especially if we now add doctors costs and blood testing) something like $25k/yr.

      (elsewhere the web says all-in it's about $100/mo on avg for commercially insured people

    • Here's another preventative method: monogamy.

      Sure, bud. [wikipedia.org]

    • Yeah, I'm sure they all drive to the clinic to pick up their meds in Rolls Royces. It really is true that the right wingers would rather see 1000 genuinely needy people suffer than one "undeserving" person cheat the system.
  • "Government regulators have been slow to crack down on insurer violations"

    There seem to be a lot of corporations that just ignore the law lately.

  • As regulatory bodies are dismantled over the next few years, these practices will become the norm, unworthy of being called out specifically. Then it's not a problem anymore.

  • US Insurers Are Still Charging for HIV Prevention Pills That Should Be Free

    No, they aren't. Patients aren't paying insurers for medications that aren't covered by their policy, that's not how insurance works!

    A person pay their insurers, and the insurer pays for covered medicines, treatments, and services, and the patient pays the pharmacy or provider for any medications, treatments or procedures that aren't covered.

    You probably meant to say something like "Some Insured Americans are paying for treatments that should be free", but that's not what you wrote...

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