Persistent Insurance Barriers and Cost-Sharing Challenges for PrEP Despite Accessibility Initiatives

A recent study conducted by researchers at the City University of New York highlights ongoing issues with insurance denials and out-of-pocket costs for pre-exposure prophylaxis (PrEP), a vital HIV prevention medication, despite regulations aimed at making it more affordable and accessible. The study, involving over 11,000 sexual and gender minority individuals across the United States, found that nearly one in four respondents (23.7%) had experienced an insurance denial for PrEP at some point, and more than a third (34.6%) faced cost-sharing for PrEP or related healthcare services within the past two years.

PrEP is widely regarded as an effective strategy to reduce HIV transmission and has been classified with a "grade A" rating by the U.S. Preventive Services Task Force, which mandates that most insurers cover the drug and associated care without patient cost-sharing. However, the research reveals that these protections are not fully effective in practice. Insurance denials were notably high for certain brand-name versions such as Descovy (48.2%) and Truvada (33.4%), whereas generic formulations like TDF/FTC saw significantly lower denial rates (8.5%). Many individuals with private insurance reported substantial out-of-pocket expenses, especially for laboratory testing related to PrEP management.

Anchored in the current policy landscape, the study's authors suggest that insurers may continue to deny coverage or impose costs selectively to influence prescribing patterns, although more research is needed to confirm these practices. The findings arrive amidst concerns over potential regulatory changes, including warnings from health officials about threats to the integrity of the USPSTF.

Lead researcher Alexa D'Angelo emphasizes the importance of maintaining strong protections for PrEP users, warning that ongoing insurance barriers undermine efforts to maximize access to HIV prevention. The study underscores the need for expanded coverage and increased funding to support PrEP delivery, ensuring it remains a critical tool in the fight against HIV transmission.

For further details, the full study is published in Health Affairs: [DOI: 10.1377/hlthaff.2025.00037].