US Insurers Are Still Charging for HIV Prevention Pills That Should Be Free (msn.com) 88
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."
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."
for profit healthcare needs to go! (Score:3, Insightful)
for profit healthcare needs to go!
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Always some asshole that needs to make a statement like yours. Great job!
Re: for profit healthcare needs to go! (Score:2, Funny)
I think the point is that TANSTAAFL is universal. Sure, people like rsilvergun argue all the time based on the idea that every unseen cost is equal to no cost because that is his lived experience within Plato's cave. But despite his denials, there's a whole other world he's never seen, and he'll die of old age within two decades, never having seen it.
Re: for profit healthcare needs to go! (Score:3)
Hack your way through the forest to get to someone who will sell you filled milk and tainted meat. It's up to you to make sure it won't make you sick or kill your children. After all, the free market should stop these from being iyn the market.
Of course it did not work like that. Change the name, move to a new city with your profits and start over again.
Now you could have non government certification, but without the government to prevent fraudulent copying of the certification...
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Hack your way through the forest to get to someone who will sell you filled milk and tainted meat. It's up to you to make sure it won't make you sick or kill your children.
They might even get a kick out of poisoning his kids. That would be understandable, and without courts, fair game.
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No, the Free Market does actually work. It only takes a critical mass of stiffs piling up before the Free Market puts an end to the companies producing the stiffs. Of course, these days there is always a vocal minority that will insist the Stiff Problem is a Fake News and will give you numerous reasons why it does not occur, or if it does, then it is not really a problem because we can move the stiffs out of sight and not have to walk by them. Hence we need to protect those companies being accused of causin
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Yay!! (Score:2)
US Insurers Are Still Charging for HIV Prevention Pills That Should Be Free.
Welcome to capitalism.
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Re: Yay!! (Score:1)
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You seem to think there are only two choices.
Re: Yay!! (Score:3, Funny)
He's American, so the only choices in his head are whatever he's currently got and communism.
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In this example, the healthca
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How dare the people who make the meds, the materials, the other costs, etc, etc expect to be paid? The nerve!
The affordable Care act is going to get repealed (Score:2, Insightful)
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 goin
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The leopards are going to eat very very well
You mean the extremely corrupt, amoral, cheating wealthy are going to eat very, very well.
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Yes, the leopards.
It's from the Leopards Eating People's Faces party. The one that people vote for while inexplicably believing that the leopards won't eat their face.
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It's not 2016. The Republicans' playbook on the ACA is now defund rather than repeal. Of course, to anyone who already lives in one of the states* which rejected the ACA subsidies in the first place, it makes little difference. It sucks for the people who will be paying more for their health insurance, but seeing as how 59% of Americans are already insured through their employer (according to Google), it's probably more a case of "I got mine" than people who voted for a leopard to eat their face. [nytimes.com]
Asking C
Like I said it depends on how much power (Score:2)
Assuming nobody stops them with their power fully consolidated they don't have to listen to us or care about us anymore. Any more than Vladi
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Morons willingly handed over control to people whose overt interest is building power and wealth for themselves and whose motto is "you're fired". People voted to allow their neighbor to get denied healthcare so that some rich dude who has more money than they would ever need can grab even more it.
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I never heard of people willingly inviting a billionaire cartel to rule them. This is like chickens voting to hire a wolf as their security guard.
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It is unlikely that the GOP will have enough of a majority to repeal the ACA -but it's funding is up for renewal in 2025.
The likely result of this is an abandoned and unenforced set of requirements (like the one in the article) and no funding for subsidizing insurance for Americans who do not have insurance thru their employers. The wealthy don't need insurance to receive care, the middle class have health insurance paid by their employers, and the poor will have to do without medical care.
A modest proposal... (Score:1)
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I actually know someone who was involved in a ...love square. 4 gay guys all having sex with one another. One was HIV positive. The rest were on PrEP.
When I asked if there was some shortage of gay guys to fuck that required inclusion of a known HIV-positive person into the mix, I got a shoulder shrug. I'd never take the risk, but they did. And PrEP is good enough that it'll probably work out for them - it has for years now.
he's going to kill education too (Score:1)
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If the govt wants it to be free, the govt should pay for it.
The government should have taken over the function of for-profit insurance middlemen decades ago, and freed up all those people to do something actually productive in society.. But the insurance companies have successfully fought tooth and nail to prevent that.
So they can suck it up.
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The ACA is a confused mess. Don't expect it to make any sense.
just get the drugs in canada (Score:2)
just get the drugs in canada
PrEP is a Faustian bargain to begin with. (Score:3)
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.
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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 sa
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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.
Re: PrEP is a Faustian bargain to begin with. (Score:4)
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...
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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
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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
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And if people were actually able to do that, you would have a point. You do not and you are just being an asshole here.
Re: Free free free (Score:2, Insightful)
People really aren't able to refrain from giving it to random strangers? Wow. I didn't know that. If people really can't control themselves, I guess we shouldn't hold it against them. #legalizerape /sarc, in case you need the joke explained to you.
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People really aren't able to refrain from giving it to random strangers?
There seems to be this prevailing belief among some nerds that if sex was consequence-free, they'd be more likely to actually get some. It's depicted quite frequently in sci-fi, where there's some uninhibited alien human society that's all about free love and they can't wait to get their snu-snu on. There's even a trope for it. [tvtropes.org]
As a gay guy, I noticed this a lot because I'd be watching ST:TNG and it'd be like ugh, not another episode where the writers are pandering to horny straight teenage boys, again.
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Sounds like a Gamma belief structure.
The truth is that horny straight teenage boys don't get laid because they have nothing to offer women. Those who do, get laid. My experience with gay friends is that there is a dynamic at work there also, but it is not the same one that works with women.
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My experience with gay friends is that there is a dynamic at work there also, but it is not the same one that works with women.
Gay men can be surprisingly catty with each other. It's one of those things straight folks usually don't expect, because often they believe the stereotypes about gay promiscuity. It's far more likely that if you just put two random gay men together that they'll just start arguing about politics, disagreements over pop artists, or how the other is annoyingly too feminine or masculine.
So yeah, the dynamic mostly is that they'd rather fuck than argue, and the stars don't usually align that way.
Re: Free free free (Score:2)
You know...if you put a random straight man and a woman together, chances are pretty slim they'd start fucking too. Unless of course they're one-dimensional marionettes in someone's fantasy, rather than real people.
Re: Free free free (Score:2)
Yes, there is a lot of sad shit between writers' ears that somehow makes it to the page and sometimes to the screen. Real life is both much more mundane, but in the end more satisfying.
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And if people were actually able to do that, you would have a point.
So, if I suddenly feel an overwhelming urge to drive down to Miami and blow the rent money on a hotel and plate of stone crabs at Joe's, can I use this excuse or does it only work for sex?
Re: Free free free (Score:2)
Only anonymous gay sex, certain kinds of drugs (ie only injectables that cause necrosis), going 150k in debt for a degree in qweirdo and/or race-baiter studies, and potentially for living beyond your means in NYC or LA while working for your big break in TV, film, or publishing.
That's all fair game for calling dibs on other people's money. Everything else is still on you.
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Only anonymous gay sex
Sounds like something I could try with my partner to spice things up in the bedroom, but how do you keep the Guy Fawkes mask from falling off?
Re: Free free free (Score:2)
Soldering and brazing. TIG welding if you're serious.
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You know what else is free? Not fucking anything that moves. And you know what's even more free than that? Not fucking multiple random anythings that move in quick succession as a matter of habit.
Same self-important dipshits that had absolutely no problem telling all us regular people to refrain from breathing near each other because contagious disease that gives you the sniffles seem to have a whole lot of problems with warning against anonymous casual sex that can lead to something considerably worse than the sniffles and a fever.
It's almost as if preventing communicable disease isn't the objective, but screwing over the majority for the benefit of a small minority is the objective.
You know what else is free? Thinking before you say stupid shit.
Re: Free free free (Score:1)
But I did think. What I thought was, "we shouldn't structure our society in a way that requires the many to assume the financial risk for voluntary and elective dangerous behaviors of the few."
Re: Free free free (Score:2)
Re: Free free free (Score:2)
Yes. And we should enforce the anti-monopoly laws we've had on the books for over a century do that no one business is too big to fail.
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But I did think
Oh well that's just sad then.
Re:Free free free (Score:5, Informative)
You know what else is free? Not fucking anything that moves.
Why am I not surprised that RightwingNutjob would suggest abstinence is the appropriate public health policy.
Re: Free free free (Score:2, Interesting)
There's a long way from promiscuity to abstinence. Deconstruct the binary.
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Do you even know what PrEP is and its purpose? It is for people too lazy to use condoms. Yes, that's it. How much does a year of condom consumption cost? Why should PrEP be cheaper than that? Or subsidized at all when there is an excellent substitute in condoms?
Re: Free free free (Score:2)
s/lazy/drunk and high/
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as far as HIV goes it's still primarily among MSM community (70% of new cases in US are still among admitted MSM ( https://www.cdc.gov/hiv/data-r... [cdc.gov]) and that's the primary market for PrEP.
A vanishingly small number of people (MSM, sex workers, needle drug users) for whom PrEP is approved / recommended would choose to pay $20k / year for that insurance. Most literally can't and even most of those who technically could wouldn't pay that much.
So... yes it's a socialized cost to try to both help people who w
Re: Infection; from pre to worse? (Score:1)
Don't worry ... (Score:3)
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.)
$200 (Score:2)
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
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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.
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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
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Sure, bud. [wikipedia.org]
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So our government is corrupt? (Score:2)
There seem to be a lot of corporations that just ignore the law lately.
Other meds (Score:2)
If I take heart disease and diabetes prevention meds can I demand they be free too?