Addressing Explanation of Benefits as a Barrier to PrEP for Adolescents in Public Health Entities

Pre-exposure prophylaxis (PrEP) is a revolutionary medical advancement to prevent HIV infection upon exposure. However, since its introduction in 2012, PrEP largely remains inaccessible to adolescents who do not wish to disclose their PrEP usage through an explanation of benefits (EOBs) and who are covered under a parent/guardian insurance. This literature review uniquely documents the concept of insurance as a barrier to PrEP access because of EOBs and how non-governmental organizations (NGOs), including community-based organizations (CBOs), have addressed this insurance policy problem. Based on the results of this review, a new approach to resolving EOBs as a barrier to PrEP access for adolescents has the potential to be implemented at the state level across the country. The approach focuses on clarifying the definition of "endanger" under HIPAA to grant adolescents the privilege of medical disclosure as it relates to EOBs.