Health Aff (Millwood). 2025 Aug;44(8):977-985. doi: 10.1377/hlthaff.2025.00037.
ABSTRACT
Despite coverage regulations requiring most insurers to cover pre-exposure prophylaxis (PrEP) without cost sharing, insurance coverage issues and cost-sharing practices persist. In this study, we assessed the prevalence of denials and cost sharing associated with PrEP among sexual and gender minority people in the US. Between August 2022 and July 2023, we recruited, via geosocial networking applications, sexual and gender minority people, who completed a screening survey for an HIV prevention study. Of 11,410 participants reporting current or former PrEP use, 23.7 percent had ever experienced a denial for their PrEP, ranging from 8.5 percent for generic tenofovir disoproxil fumarate and emtricitabine to 48.2 percent for Descovy. In addition, 34.6 percent reported cost sharing within the prior two years. The majority (58.3 percent) of cost-sharing instances were for laboratory bloodwork, and most (61.5 percent) were among privately insured people. Continued insurance denials and cost sharing associated with PrEP necessitate further policy intervention to address gaps in coverage, billing errors, and challenges resulting from formulary tiering.
PMID:40758923 | DOI:10.1377/hlthaff.2025.00037
