The proposal of a new federal standard aims to protect older Americans from contracting HIV by offering free preventative medications, the most recent effort to reach much of Europe and Africa in the fight against the spread of the virus.
Under the Biden administration’s plan, Medicare would cover Total cost of pre-exposure prophylaxis medications, which prevent the transmission of HIV. The drugs, known as “PrEP,” would be free in pill form and, for the first time, as long-acting injectables through the government insurance program for people 65 and older.
People aged 50 or older represent half of those already living with HIV in the country.
The proposed policy change represents a big shift because it means that even the new long-acting injectable versions of PrEP medications, which They can cost more than $20,000 a year In the United States, they would be completely covered, without the need for patients to contribute co-payments.
However, it’s still unclear what the plan would mean for taxpayers, either in paying for drugs or in offsetting the costs of caring for fewer Medicare patients with HIV in the future.
The new plan was expected to get the green light on Oct. 10, but the Centers for Medicare & Medicaid Services (CMS) announced it was still working out the details of how to transition coverage for patients already taking the drugs. .
The United States is decades behind nations in Europe and Africa that are on track to end new HIV infections by 2030.
But while the proposal should reduce infections among older Americans, it highlights inequalities that persist: Many people under 65 will still struggle to pay for PrEP.
At the same time, Republican congressional leaders have threatened to cut funds for a federal HIV prevention effort led by the Trump administration and aimed at helping everyone who is at risk.
“We have done a very poor job in the United States of ensuring that the people who could benefit most from PrEP have access,” said Justin Smith, who directs the Campaign to End AIDS for the United States. Positive Impact Health Centers in the Atlanta area.
Although PrEP has been embraced by gay and trans Americans, it is less commonly prescribed to heterosexuals over 50 or to women of any age.
In the first three months of this year, only 8% of the more than 300,000 people who received PrEP in the United States were women, according to the Centers for Disease Control and Prevention (CDC).
The racial gap is also large: While 66% of non-Hispanic whites eligible for PrEP filled prescriptions in that period, only 8% of eligible non-Hispanic blacks and 17% of eligible Hispanics filled them.
Expand access for gay and bisexual men of color, as well as heterosexual and cisgender women of color, —particularly black womenthat represent the majority of women with HIV in the country as well as the majority of new infections among women — is critical for the nation to catch up with the rest of the world, Smith said.
Leisha McKinley-Beach, national HIV consultant and executive director of the Black Public Health Academywhich trains Black health department employees for leadership positions, noted that Medicare’s proposal to cover the cost of injectable PrEP could help many women: An injection every two months may be easier to manage than a pill daily.
But it’s just a beginning. McKinley-Beach and others are pushing for a national PrEP plan that would build on the momentum of the recent Medicare proposal to expand free access to other age groups, much like what is happening with Covid vaccines. 19.
McKinley-Beach also wants the U.S. government to expand the message that anyone can get HIV, encourage drug companies to do more television advertising aimed at women of color, and fund outreach efforts to dispel medical mistrust. in communities of color.
“White gay men have had a narrative of dignity and respect regarding HIV treatment, and I would never want to change that narrative,” he said. “But it is necessary to broaden the message. “Forty-two years after the start of the HIV epidemic, the current prevention model is harmful to Black women who could benefit from PrEP.”
Although the United States was the first country in approving PrEP, in 2012, it now lags behind the rest of the world in equitable access.
This is primarily due to the cost of lab tests and doctor visits. While the cost of generic Truvada, an oral form of PrEP, in the United States can be as low as about $30 per month, a study by researchers at the University of Virginia found that the cost of starting PrEP is often about $2,670 for uninsured patients, including about $1,000 for lab tests and doctor visits.
The new Medicare proposal would cover up to seven counseling visits every 12 months for HIV risk assessment and reduction.
Meanwhile, PrEP pills are free in the UK and EU countries. European Union, including France, Germany, Sweden and Denmark. These nations do not yet cover the more expensive shots, although the United Kingdom is leading a small trial of injectable PrEP in people who cannot take it in tablet form.
The United States also lags behind Western Europe and some African nations in overall HIV treatment and prevention.
For example, only 57% of HIV-positive Americans have achieved viral suppression, according to the US government website HIV.gov, which means they take medication regularly so they do not transmit the virus. That makes PrEP, which is for people who do not have the virus, even more important for Americans to remain negative, according to HIV experts.
In Africa, on the other hand, Botswana, Eswatini (formerly Swaziland), Rwanda, Tanzania and Zimbabwe have already reached the “95-95-95” objectives of the United Nations set for 2025: 95% of people with HIV know their status. 95% of people diagnosed with HIV infection receive consistent antiretroviral therapy; and 95% of those receiving antiretroviral therapy have achieved viral suppression (when the virus is undetectable in the blood), according to the United Nations Organization (UN).
In the United Kingdom, the 98% of people HIV positive people have reached “undetectable” status thanks to free antiretroviral drugs and treatment available through the country’s universal healthcare program, the National Health Service (NHS).
Additionally, almost anyone in the UK who is HIV negative and wants to take PrEP can get it free of charge. The nation says it is now on track to reduce new HIV infections by 80% by 2025.
The UK changed its approach to PrEP after 2015, when Greg Owen founded “iwantprepnow.co.uk”, a website that started a PrEP movement by helping people in the United Kingdom and Europe to self-supply low-priced generic forms of Truvada, the first drug. approved as PrEP, in pharmacies in India and Hong Kong.
“It became more affordable,” said Owen, now PrEP leader at one of the UK’s leading HIV and sexual health charities, Terrence Higgins Trust. “Soon people were demanding it for free on the NHS.”
Smith said that in the United States, the lack of a national PrEP program that would make the medications and associated blood tests free, and a heated political climate around health care, have hampered HIV disclosure.
“In the rural South, especially places like Georgia or Tennessee, there has been open hostility toward accepting money from the CDC and Medicaid expansion to treat and prevent HIV,” Smith said. “People think it’s just politics, but this is having an impact on public health, on people’s lives.”
Anti-queer sentiment in many quarters also creates an environment of hostility around sexual health in general, she said. Richard Elion, director of clinical research at the Washington Health Institute and professor at the George Washington University School of Medicine and Health Sciences. “There is a chilling effect for everyone, not just queer Americans,” he said.
Elion said the shame surrounding sex and the feeling of vulnerability some people feel when taking any medication may also reduce PrEP use among older Americans. “Taking PrEP is actually very empowering, and that should be the message,” she said.
This story was produced by KFF Health News, a national newsroom focused on in-depth coverage of health issues, which is one of the main programs of KFFthe independent source for health policy research, polling and journalism.
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