The Colorado Division of Insurance (“DOI”) has announced that, because the U.S. Preventive Services Task Force (“USPSTF”) has determined that the prescription drug Pre-Exposure Prophylaxis (“PrEP”) will be considered a preventive treatment for health benefit plans beginning in 2021, these plans will be required to cover PrEP without co-payment, coinsurance, or deductibles from plan enrollees.
The DOI explained that PrEP is a highly effective drug in preventing HIV transmission, and is recommended for anyone at risk of contracting HIV. Truvada is the brand name for PrEP, but a generic version of it is expected in 2020, which should decrease the drug's costs, the DOI said.
“We commend the USPSTF for adding PrEP to the list of covered preventive treatments,” said Colorado's insurance commissioner, Michael Conway. “This puts a highly effective medication within reach of those who need it, and it will save lives.”
The DOI said that it will work with insurance carriers, consumer groups, and other stakeholders this year and into 2020 to develop regulations around this determination so that it will be reflected in the health benefit plans for 2021 that will need to be filed with the DOI in the summer of 2020.
The USPSTF is an independent, volunteer panel of national experts in disease prevention and evidence-based medicine that makes recommendations about clinical preventive services. The USPSTF determines which procedures and medications are considered preventive by grading them. As provided by the Affordable Care Act (“ACA”), any preventive measures graded “A” or “B” must be covered by health benefit plans and must not require payment from plan enrollees.
In November 2018, the USPSTF issued a draft recommendation to include PrEP for an “A” grade, and that recommendation now has been finalized.
Learn more: dora.colorado.gov/insurance.
Steven A. Meyerowitz
Steven A. Meyerowitz, a Harvard Law School graduate, is the founder and president of Meyerowitz Communications Inc., a law firm marketing communications consulting company. He may be contacted at [email protected].