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Weeks after Truvada (tenofovir and
emtricitabine) received US approval for HIV prevention in adults at high risk
of infection, it remains unclear whether government and private health insurers
would pay for it. Regulatory approval of Truvada for pre-exposure prophylaxis
(PrEP) followed years of speculation about whether it would curb new
infections.
“Instead of just trying to
distribute it in massive numbers, we need to understand how we’ll deliver PrEP,
and to whom we’ll deliver PrEP, along with making a good case for whatever
investment that will require,” said Mitchell Warren, executive director of the
AIDS Vaccine Advocacy Coalition.
Demonstration projects by the
National Institutes of Health and the California HIV/AIDS Research Program will
focus on possible implementation strategies for specific groups. Warren said he
is looking forward to these trials and would like private insurers and Medicaid
and Medicare to cover PrEP.
Michael Weinstein, president of AIDS
Healthcare Foundation, pledged his organization would oppose Medicare or
Medicaid coverage. “We believe this will lead to more infections,” Weinstein
said of Truvada’s approval for PrEP. Government insurance coverage for it would
be a “bad use of public funds,” he said.
A Centers for Medicare and Medicaid
Services (CMS) spokesperson could not comment on a possible PrEP coverage
decision. However, Truvada prescribed as part of antiretroviral therapy for
people with HIV has been on Medicare Part D formularies for several years, he
noted.
Most private insurers pay for
Truvada prescribed as treatment, said Susan Pisano, a spokesperson for America’s
Health Insurance Plans. AHIP members usually base coverage decisions on medical
reviews, clinical trial reports, and decisions by federal agencies including
CMS. But it is too early to say whether members will pay for PrEP, she said.
The Friends of AIDS Foundation is
dedicated to enhancing the quality of life for HIV positive individuals and
empowering people to make healthy choices to prevent the spread of the HIV
virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.
TOGETHER WE REMAIN STRONG!
