Insurance Denials And Cost Sharing For PrEP Among Sexual And Gender Minority People

Area of Science:

• Public Health
• Health Policy
• HIV Prevention

Background:

• Regulations mandate insurance coverage for pre-exposure prophylaxis (PrEP) without cost sharing.
• Despite regulations, persistent insurance coverage issues and cost-sharing practices hinder PrEP access.
• Sexual and gender minority populations are disproportionately affected by these barriers.

Purpose of the Study:

• To assess the prevalence of insurance denials for PrEP.
• To determine the frequency of cost sharing associated with PrEP.
• To examine these issues among sexual and gender minority individuals in the US.

Main Methods:

• Recruitment of sexual and gender minority individuals via geosocial networking applications.
• Administration of a screening survey to assess current or former PrEP use.
• Data collection on experiences with PrEP denials and cost sharing between August 2022 and July 2023.

Main Results:

• 23.7% of 11,410 participants reported ever experiencing a PrEP denial.
• Denial rates varied by medication, from 8.5% for generic TDF/FTC to 48.2% for Descovy.
• 34.6% reported cost sharing in the prior two years, primarily for lab work (58.3%) and among privately insured individuals (61.5%).

Conclusions:

• Continued insurance denials and cost sharing for PrEP impede access to HIV prevention.
• Policy interventions are needed to address coverage gaps, billing errors, and formulary tiering challenges.
• Ensuring equitable access to PrEP is crucial for sexual and gender minority health.