The department found that several payers are shifting the cost of preventive screenings, diagnosis and treatment of STIs to consumers, fueling the spread of HIV, syphilis, chlamydia and hepatitis. The ACA and California law ban “the practice of limiting periodic STI screenings of persons who are at increased risk of infection in ways that deprive consumers of equitable coverage of clinically recommended preventive care.”
California law also requires most payers to cover screening, diagnostic testing and treatment of any health condition according to current and generally accepted care standards.
Federal and state law also requires payers to:
- Cover STI screenings within the scope of the ACA without cost-sharing.
- Cover clinically recommended STI screenings that are not defined as preventive care under the ACA.
- Not impose coverage limits on STI screenings that conflict with evidence-based clinical recommendations on screening intervals.
- With pharmacy benefits, payers must cover prescription drugs that are medically necessary to treat STIs, including antivirals for hepatitis C.
- Cover home self-collection test kits and laboratory costs for STI detection.
- Cover combination antigen/antibody HIV self-tests, including combination rapid fingerstick tests, without a deductible from or other cost-sharing on patients.
