Understanding PrEP Coverage Under the Affordable Care Act
What is PrEP?
PrEP (pre-exposure prophylaxis) is a medication that helps prevent HIV infection in people who are at high risk of exposure to the virus. It is taken daily as a pill and is highly effective when used correctly.
Does the Affordable Care Act (ACA) cover PrEP?
Yes, the ACA requires most health insurance plans to cover PrEP without cost-sharing (such as deductibles, copayments, or coinsurance) for people who are at high risk of HIV infection. This coverage is available to people regardless of their age, sex, sexual orientation, or gender identity.
Who is considered high risk for HIV infection?
The Centers for Disease Control and Prevention (CDC) considers the following people to be at high risk for HIV infection:
Men who have sex with men
People who inject drugs
People who engage in unprotected anal or vaginal sex with an HIV-positive partner
People who have been diagnosed with a sexually transmitted infection (STI) in the past year
People who have had multiple sexual partners in the past year
People who have been incarcerated
How do I get PrEP coverage under the ACA?
If you are at high risk for HIV infection, you should talk to your doctor about getting a prescription for PrEP. Once you have a prescription, you can use your health insurance to cover the cost of the medication. You may need to get a prior authorization from your insurance company before you can get coverage for PrEP.
What if I don’t have health insurance?
There are a number of ways to get PrEP if you don’t have health insurance. You can:
Contact your local health department or community health center. They may be able to provide PrEP for free or at a reduced cost.
Apply for Medicaid or the Children’s Health Insurance Program (CHIP). These programs provide health insurance to low-income individuals and families.
Use a payment assistance program. These programs can help you pay for the cost of PrEP.
Where can I learn more about PrEP?
You can learn more about PrEP from the following resources:
The CDC: https://www.cdc.gov/hiv/basics/prep.html
The National Institutes of Health (NIH): https://www.nichd.nih.gov/health/topics/prep/conditioninfo/Pages/default.aspx
The PrEP Locator: https://preplocator.org/
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