Why Are We Delaying Coverage of New HIV Prevention?

At first glance, the U.S. Preventive Services Task Force’s (USPSTF) December 13, 2022, release of its draft updated recommendations for Prevention of HIV Infection: Pre-Exposure Prophylaxis (PrEP) is a positive development in increasing access to PrEP and accordingly preventing transmission of HIV. However, belying progress in this space is the reality that private payers will not be required to provide coverage of long-acting injectable (LAI) PrEP with zero patient out-of-pocket costs (known as first dollar coverage) for years, until January of 2025 or 2026.

The USPSTF’s recommendations were released just one week shy of the one-year anniversary of the Food and Drug Administration’s (FDA’s) approval of cabotegravir, a new LAI form of PrEP that is administered every two months. LAI PrEP is the latest iteration in an increasingly successful progression of antiretroviral therapy and PrEP products that reduce HIV transmission. Injected at two-month intervals, it is revolutionary for its duration of protection, which improves patient adherence to the PrEP regimen. Increased patient adherence to the regimen is directly correlated with lowering the risk of transmission. For patients who struggle with adherence, LAI PrEP is a game-changer. Yet, this innovation must contend with the fragmented system of prevention policy governance, which threatens to impair clarity for payers and providers and, most concerningly, prevents patients from accessing the protection they need from HIV infection.