The DC Council unanimously voted to advance legislation that would require health insurance companies to cover the cost of HIV prevention drugs, including those used for pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP).
The vote came after the board unanimously approved an amendment that removed language added in committee that required insurers to fully cover only one PrEP drug of their choice.
The revised bill states that for plans issued or renewed after January 1, 2027, insurers “may not impose cost-sharing, require prior authorization, or impose medically unnecessary restrictions or delays on the development of HIV prevention services, PEP, or FDA-approved PrEP.”
Currently, there are two FDA-approved oral medications primarily used as PrEP. Truvada (generic versions also available) and Descovy (both manufactured by Gilead Sciences).
Recent scientific advances have led to the development of two FDA-approved long-acting injectable forms of PrEP. One is ViiV Healthcare’s Apretune, which requires injections every two months. The other is Gilead’s Lenacapavir, sold under the name Yeztugo and requires injections every six months.
The bill was introduced by D.C. City Councilman Zachary Parker (D-5th District), who sponsored a measure that would ensure area residents with health insurance would continue to have access to HIV prevention drugs regardless of the Trump administration’s decision.
“Infection rates are at 30-year lows, and federal funding cuts are putting that progress in jeopardy,” Parker said. metro weekly. “It was also very important that we enshrined these protections, which are currently provided by the Affordable Care Act, into local law. We know there have been repeated attempts to roll back the Affordable Care Act, so it was important that these protections take root locally so that our residents can rely on them no matter what happens at the federal level.”
Karl Schmidt, executive director of the HIV+Hepatitis Policy Institute, said that while the Supreme Court has upheld the constitutionality of the U.S. Preventive Services Task Force, it remains unclear how the Trump administration will treat the organization, which plays a key role in determining which preventive services insurers must cover it at no additional cost.
“The entire Supreme Court case is [around the task force] “It was brought in by conservatives because of their opposition to PrEP, but in the end PrEP ended up pursuing a full range of preventive services,” Schmidt said on a recent phone call. And even if the courts rule in its favor, we don’t know what the Trump administration plans to do with the U.S. Preventive Services Task Force… Its future feels like it’s still up in the air. You can also roll back your PrEP protection. That was the basis [Parker’s] A bill has been introduced. ”
Schmidt and other supporters testified in favor of the bill before the House Health Committee. But after a public hearing, the committee approved the measure, which included language requiring insurers to cover only one type of PrEP drug, rather than multiple forms of PrEP. It was a change that advocates did not want, and one that raised concerns among many HIV prevention experts.
“Essentially, people are in a situation where their plan only covers cheap once-a-day generic PrEP, which is fine for some people, but other people need long-acting PrEP,” Schmidt said. “There was a concern that insurance companies wouldn’t cover the newer long-acting PrEP. So when we heard that, we were disappointed and said, ‘Wait, what happened? This is terrible.'”
After the bill was shuffled around between committees following a change in leadership, advocates were busy warning lawmakers about language that could weaken the bill ahead of the Feb. 3 vote.
On the day of the first vote, Henderson and Parker proposed an amendment that would require insurance companies to cover all FDA-approved HIV prevention drugs, including those used for post-exposure prophylaxis, as well as future treatments approved for HIV prevention.
The bill also incorporates provisions from another law introduced by City Councilwoman Brooke Pinto (D-2nd District) that would prohibit life and disability insurance companies from discriminating against people on PrEP, a move supporters welcomed.
“Insurance companies often think you’re at higher risk because you’re on PrEP, but in reality, you’re taking responsible steps to protect yourself from HIV,” Schmidt says.
Schmidt added that he hopes the bill passes its required second reading without any further changes, saying the measure is needed to provide relief to people who are actively trying to protect themselves from HIV.
Parker said. metro weekly The original language to cover only one regimen of PrEP was introduced “at the behest of insurance companies” who had lobbied the council and provided feedback to the health board, he said.
“It’s clear that the insurance companies were fighting and resisting some of this,” he said. “I think that’s why the changes were made. But it’s also possible that people just don’t have deep knowledge about the different forms of PrEP.”
Parker, the council’s only gay member, said he is knowledgeable about HIV prevention as a member of the LGBTQ community and emphasizes the importance of political representation.
“My insights and perspectives on access to PrEP, and the difficulties my friends and others have encountered in gaining access to PrEP, directly influenced the creation of this bill,” he said.
After the City Council votes a second time on the PrEP access bill, it will be sent to D.C. Mayor Muriel Bowser for her signature. Parker expects Bowser to approve the bill and subject it to parliamentary scrutiny, as is required of all legislation passed by Congress.
“We hope to have legislation by this spring in time for the changes to go into effect for fiscal year 2027,” Parker said. “By this summer, people should start seeing these changes reflected in their insurance coverage.”
Source: Metro Weekly – www.metroweekly.com
