HIV prevention drugs for older Americans could be free under new Biden proposal

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This is a KFF Health News story.

A proposed federal policy aims to protect older Americans from HIV by providing free preventative medications, the last effort catching up with much of Europe and Africa in the fight against the spread of the virus.

Under the Biden administration’s plan, Medicare would cover all patient costs 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 thanks to the government insurance program designed for people 65 and older. Those aged 50 and over compensate half of all people in the United States already living with HIV.

The proposed policy change represents a significant change because it means that even new long-acting injectable versions of PrEP drugs, which can cost in the United States, more than $20,000 per year, would be fully covered, without patients having to pay a co-pay.

It’s not yet clear what this plan would mean for taxpayers, either paying for the drugs or offsetting the costs of caring for fewer Medicare patients with HIV in the future.

The final green light for the plan was expected October 10, but the Centers for Medicare & Medicaid Services announced that it is still working out the details of transitioning coverage for patients already taking the drugs.

The United States is decades behind countries in Europe and Africa that are on track to end new HIV infections by 2030. But whether the proposal should lower infections among Americans older, it highlights the inequalities that remain: many people under 65 will still struggle to pay for Preparation. And at the same time, Republican leaders in Congress have threatened to cut funding for a federal HIV prevention effort championed by the Trump administration and intended to help everyone at risk.

“We have done a very poor job in the United States of ensuring that people who could benefit most from PrEP have access to it,” said Justin Smith, who leads the Campaign to End AIDS in Positive impact health centers in the Atlanta area.

Although PrEP has been adopted by gay and trans Americans, it is less often prescribed to heterosexuals over 50 or women of any age. During the first three months of this year, only 8% of more than 300,000 people receiving PrEP in the United States were women,

according to the Centers for Disease Control and Prevention. The racial gap is also significant: while 66% of white people eligible for PrEP received a prescription during this period, only 8% of eligible black people and 17% of eligible Hispanic people did so.

Expanding access to gay and bisexual men of color, as well as heterosexual and cisgender women of color – especially black womenWHO represent the majority of the number of HIV-positive women in the United States as well as the majority of new infections among women – is critical for the country to catch up with the rest of the world, Smith said.

Leisha McKinley-Beach, national HIV consultant and CEO of Academy of Black Public Healthwhich prepares Black health department employees for leadership positions, noted that Medicare’s proposal to cover the cost of injectable PrEP could help many women, because an injection administered every two months may be easier to manage only one daily pill.

But this is only the beginning. She and others are pushing for a national PrEP plan that would build on the momentum of Medicare’s recent proposal to expand free access to other age groups, just as with COVID vaccinations -19.

McKinley-Beach also wants the U.S. government to broaden the message that anyone can get HIV, encourage pharmaceutical companies to advertise more on television to women of color, and fund outreach to dispel medical mistrust in communities of color.

“White gay men have a narrative of dignity and respect when it comes to HIV treatment, and I would never want to change that narrative,” she said. “But the message needs to be broadened. Forty-two years into the HIV epidemic, the current model of HIV prevention is detrimental to Black women who could benefit from PrEP.”

Even though the United States was the first nation to approve PrEP in 2012, it now lags behind the rest of the world in equitable access. This is mainly due to the cost of laboratory tests and medical visits.

While the cost of the generic form of Truvada, an oral form of PrEP, can be as low as around $30 per month in the United States, a study According to researchers at the University of Virginia, the cost of starting PrEP is typically 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 for people in the UK and European Union countries including France, Germany, Sweden and Denmark. These countries do not yet cover the more expensive injections, although the United Kingdom is running 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 countries in HIV treatment and prevention. For example, according to the U.S. government website, only 57% of HIV-positive Americans have achieved viral suppression. hiv.gov, meaning they regularly take medications to make them unable to transmit the virus. T

That makes PrEP, intended for people who do not carry the virus, all the more important for Americans to stay negative, HIV experts say.

In Africa, on the other hand, Botswana, Eswatini (formerly Swaziland), Rwanda, Tanzania and Zimbabwe have already achieved the targets set by the United Nations. “95-95-95” targets set for 2025: 95% of people living with HIV know their HIV status, 95% of people diagnosed with HIV are receiving sustained antiretroviral therapy, and 95% of people receiving antiretroviral therapy have achieved viral suppression or the virus is undetectable in their blood. — according to the UN

The UK, 98% of people with HIV have achieved “undetectable” status thanks to free antiretroviral drugs and treatments available under the country’s universal health care program, the National Health Service. Additionally, in the UK, almost anyone who is HIV-negative and wants to take PrEP can get it for free. The United Kingdom 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 “jeveuxprepnow.co.uk“, a website that sparked a PrEP movement by helping people in the UK and Europe self-stock low-cost generic forms of Truvada, the first drug approved as PrEP, from pharmacies across Hong Kong Kong and India.

“It’s become more affordable,” said Owen, now head of PrEP at one of Britain’s leading HIV and sexual health charities. Terrence Higgins Trust. “Soon people were asking for it for free on the NHS.”

In the United States, Smith said, the lack of a national PrEP program that would make the drugs and associated blood tests free, as well as the tense political climate around health care have hampered HIV awareness.

“In rural areas of the South, particularly in places like Georgia or Tennessee, there has been outright hostility toward accepting CDC money and Medicaid expansion to treat and prevent HIV,” Smith said. “People think it’s just politics, but it impacts public health and people’s lives.”

Anti-queer sentiment in many circles also creates an environment of hostility around sexual health in general, said Richard Élion, 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 gay Americans,” he said.

Elion said gender stigmas and feelings of vulnerability that some people feel while taking medications may also reduce PrEP uptake among older Americans. “Taking PrEP is actually very empowering, and that needs to be the message,” he said.

KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism on health issues and is one of the primary operating programs of KFF – the independent research source , surveys and health policies. journalism.

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