A group of eight Democrats sent a letter dated Sept. 8 to the trade association expressing “deep concern” over reports of enrollees in health plans receiving bills for PrEP medications or associated services.
The senators’ letter comes a day after a federal judge in Texas ruled ACA regulations that require employer-based plans to cover HIV prevention drugs violate religious freedoms.
The ruling could open the door to repeal the provision of the ACA that requires payers to cover preventive care, though the legal process could take years.
Current CMS regulations require payers to cover the full cost of PrEP medication and related services like labs and provider visits.
The senators cited a March report from Kaiser Health News that found some patients are still charged out-of-pocket for PrEP medications and related services.
“In light of this clear guidance from CMS, we are alarmed by continual reports that patients are routinely billed, either for payment-in-full or for cost-sharing practices, related to medically appropriate medications and essential services,” the senators wrote.
In a press release, Kenyon Farrow, managing director of advocacy and organizing for advocacy group PrEP4All, said the organization has documented dozens of cases of payers charging for PrEP-related services.
“Ending the HIV epidemic will require us to ensure everyone with insurance be able to get PrEP services with no cost-sharing, as the rule intended,” he said.
