A proposed new federal rule aims to protect older Americans from HIV infection by offering free preventative drugs, the latest effort to reach much of Europe and Africa in the fight against the spread of the virus.
Under the Biden administration’s plan, Medicare would cover the full cost of pre-exposure prophylaxis drugs, which prevent transmission of HIV. The drugs, known as PrEP, will be free in pill form and, for the first time, in long-acting injection form through the government insurance program for people aged 65 or older.
People aged 50 or over represent half of those already infected with HIV in the country.
The proposed policy change represents a major shift because it means that even newer, long-acting injectable versions of pre-exposure prophylaxis drugs, which can cost more than $20,000 a year in the United States, would be fully covered, without patients being required to co-pay for treatment. Pay.
However, it remains unclear what the plan would mean for taxpayers, both in paying for the drugs and in offsetting the costs of caring for fewer HIV-infected Medicare patients in the future.
The new plan was expected to get the green light on October 10, but the Centers for Medicare and Medicaid Services (CMS) announced it is still working out the details of how to transfer coverage to patients who already take the drugs.
The United States is decades behind countries in Europe and Africa that are on track to end new HIV infections by 2030.
But while the proposal should reduce infections among older Americans, it highlights the inequalities that remain: Many people under 65 will still struggle to pay for preventative measures.
Meanwhile, Republican congressional leaders have threatened to cut funding for federal HIV prevention efforts led by the Trump administration that aim to help everyone at risk.
“We’ve done a very poor job in the United States of ensuring that the people who could benefit most from pre-exposure prophylaxis (PrEP) get health care,” said Justin Smith, who runs the End AIDS Campaign for Positive Impact Health Centers in the Atlanta area.
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Although gay and transgender people have embraced PrEP, it is less common among heterosexuals over 50 or for women of any age.
In the first three months of this year, only 8% of the more than 300,000 people who received pre-exposure prophylaxis in the United States were women, according to the Centers for Disease Control and Prevention (CDC).
The racial gap is also large: While 66% of non-Hispanic whites eligible for pre-exposure prophylaxis filled prescriptions in that period, only 8% of eligible non-Hispanic blacks and 17% of eligible Hispanics filled them.
Expanding access to gay and bisexual men of color, as well as heterosexual and cisgender women of color — especially Black women, who represent the majority of women living with HIV in the country as well as the majority of new infections among women — is critical. . Smith said the nation would be on equal footing with the rest of the world.
Medicare’s proposal to cover the cost of pre-exposure prophylaxis injections could help, said Leisha McKinley Beach, national HIV consultant and executive director of the Black Public Health Academy, which trains Black health department employees for leadership positions. For many women: An injection every two years may be easier to administer than a daily pill.
But it’s just the beginning. McKinley Beach and others are pushing for a national disease prevention plan that would build on the momentum of a recent Medicare proposal to expand free access to other age groups, just like what is happening with Covid vaccines.
McKinley Beach also wants the US government to expand the message that anyone can get HIV, encourage pharmaceutical companies to do more TV ads targeting women of color, and fund outreach efforts to dispel medical mistrust in communities of color.
“White gay men have had a narrative about dignity and respect around HIV treatment, and I would never want to change that narrative,” he said. But it is necessary to expand the message. “Forty-two years after the start of the HIV epidemic, the current prevention model harms Black women who could benefit from pre-exposure prophylaxis.”
Although the United States was the first country to approve pre-exposure prophylaxis, in 2012, it now lags behind the rest of the world in equitable access.
This is primarily due to the cost of laboratory tests and doctor visits. While the cost of generic Truvada, an oral form of PrEP, in the United States can be about $30 per month, a study by researchers at the University of Virginia found that the cost of starting PrEP treatment is often about $2,670 for uninsured patients. , including about $1,000 for lab tests and doctor visits.
The new Medicare proposal would cover up to seven counseling visits every 12 months to assess and reduce HIV risks.
Meanwhile, PrEP pills are free in the UK and EU countries including France, Germany, Sweden and Denmark. These countries have not yet covered the more expensive doses, although the UK is leading a small trial of PrEP injections in people who cannot take it in pill form.
The United States also lags behind Western Europe and some African countries in overall HIV treatment and prevention.
For example, only 57% of Americans with HIV have suppressed the virus, according to the U.S. government website HIV.gov, meaning they take medication regularly so they don’t transmit the virus. That makes PrEP, which is intended for people who are HIV-negative, even more important for Americans to remain HIV-negative, according to HIV experts.
On the other hand, in Africa, Botswana, Eswatini (formerly Swaziland), Rwanda, Tanzania and Zimbabwe have already achieved the UN “95-95-95” targets set for 2025: 95% of people infected with HIV know their status. 95% of people diagnosed with HIV receive stable antiretroviral therapy; And 95% of those receiving antiretroviral therapy achieve viral suppression (when the virus is undetectable in the blood), according to the United Nations.
In the United Kingdom, 98% of people living with HIV have reached an “undetectable” state thanks to antiretroviral drugs and free treatment available through the country’s universal healthcare programme, or National Health Service.
In addition, almost anyone in the UK who is HIV-negative and wants to take PrEP can get it for free. The country says it is now on track to reduce new HIV infections by 80% by 2025.
The United Kingdom changed its approach to PrEP after 2015, when Greg Owen founded “iwantprepnow.co.uk,” a website that started the PrEP movement by helping people in the United Kingdom and Europe become self-sufficient in common ways. The first medicine. It is approved as PrEP, in pharmacies in India and Hong Kong.
“It’s become more affordable,” said Owen, who is now pre-exposure prophylaxis program leader at one of the UK’s leading HIV and sexual health charities, the Terrence Higgins Trust. “Soon people were demanding it for free on the NHS.”
In the United States, the lack of a national HIV prevention program that would make the drugs and associated blood tests free, and the heated political climate around health care, have hampered HIV screening, Smith said.
“In the rural South, especially in places like Georgia or Tennessee, there has been open hostility toward accepting money from the Centers for Disease Control and Prevention and expanding Medicaid for HIV treatment and prevention,” Smith said. “People think it’s just politics, but this has an impact on public health, on people’s lives.”
Anti-gay sentiment in many quarters also creates an environment of hostility around sexual health in general, said Richard Elion, director of clinical research at the Washington Health Institute and a professor at George Washington University School of Medicine and Health Sciences. “There is a chilling effect on everyone, not just gay Americans,” he said.
Shame surrounding sex and the feeling of vulnerability that some people feel when taking any medication may also reduce the use of pre-exposure prophylaxis drugs among older Americans, Elion said. “Taking PrEP is actually very empowering, and that should be the message,” she said.
By: Michael Scaturro/KFF Health News
This story was produced by KFF Health Newsa national newsroom focused on in-depth treatment of health issues, is one of the flagship programs of KFFThe independent source for health policy research, polling, and journalism.