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People with insurance will now have easier access to HIV-prevention medication

AYESHA RASCOE, HOST:

A new recommendation from the U.S. Preventive Services Task Force will make it easier for insured patients to access medication that prevents HIV. But what about those without insurance? To learn more about the new recommendation and what it means for people with HIV, we're joined by Dr. Carlos del Rio. He's a professor of infectious diseases at Emory University and the president of the Infectious Diseases Society of America. Dr. del Rio, welcome back to the show.

CARLOS DEL RIO: Happy to be with you.

RASCOE: So what exactly is the task force recommending? And how is it different from their original recommendation in 2019?

DEL RIO: Well, Ayesha, in 2019, the United States Preventive Services Task Force released a recommendation saying that the administration of a pill, which is a combination of two antiretrovirals - tenofovir and emtricitabine - was approved for the prevention of HIV infection and gave it a Grade A recommendation. And what a Grade A recommendation means is that insurance companies and Medicaid, under the Affordable Care Act, is going to pay for this, and so this is going to be provided free of charge to the beneficiary.

What happened this time around is, since 2019, a lot of science has occurred. A lot of new drugs have developed. And there's a drug which is a derivative of the initial drug. And this is a different formulation of tenofovir that has been shown to be effective for the prevention of HIV. But also, an injectable drug, which is long-acting cabotegravir, is effective in the prevention of HIV infection both in men who have sex with men and in women.

And this is really a game-changing medication because instead of having to take a pill every day, you can now have an injection given to you every two months. And if you - with that injection, essentially, you're able to prevent the acquisition of HIV infection. And what the Preventive Services has done is said, those two additional drugs also deserve a Grade A recommendation.

RASCOE: Before this new recommendation came out, the original recommendation was facing legal challenges over the requirement that insurers cover these drugs. Is there a concern that these challenges could halt this coverage?

DEL RIO: Absolutely. There is significant concern. Last year, there was a judge in Texas that essentially agreed that it was unconstitutional for the Department of Health and Human Services to mandate coverages for preventative services and, if this were to continue and be affirmed by the Supreme Court, would really upend not only PrEP - preexposure prophylaxis, a highly effective intervention to prevent HIV infection - but think about all the other things recommended by the U.S. Preventive Services Task Force - screening mammographies and screening colonoscopies. All those are Level A recommendations that, currently, Medicaid is covering or the uninsured have access to.

RASCOE: So HIV is known to disproportionately affect Black and Latino communities, as well as low-income communities. And these, you know, same groups tend to have disproportionately larger numbers of uninsured people. Is there a way to close this accessibility gap, especially for such an important medication? You know, are there charities? Are there nonprofits that are helping with this?

DEL RIO: There are. And, you know, there's patient assistance, and there are other programs. But the reality is that, at the end of the day, it's not enough. There's a group of academic researchers, of lawyers, of community advocates that have proposed a national PrEP program - really optimize PrEP access equitably because if we were to use PrEP appropriately, we would be able to really prevent many new HIV infections.

RASCOE: So then does that end up meaning that you really have to have the federal government involved here?

DEL RIO: Well, you know, I think so. I think we need a combination of the federal government. I think we need also industry to come to the table, right? Why are we paying such high prices for these medications? Now, I would tell you that, from a cost-benefit perspective, this is very cost-effective. You know, this is investment that makes sense.

RASCOE: That's Dr. Carlos del Rio. He's a professor of infectious diseases at Emory University and president of the Infectious Diseases Society of America. Dr. del Rio, thank you so much.

DEL RIO: Ayesha, delighted to be with you. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Ayesha Rascoe is a White House correspondent for NPR. She is currently covering her third presidential administration. Rascoe's White House coverage has included a number of high profile foreign trips, including President Trump's 2019 summit with North Korean leader Kim Jong Un in Hanoi, Vietnam, and President Obama's final NATO summit in Warsaw, Poland in 2016. As a part of the White House team, she's also a regular on the NPR Politics Podcast.
Lennon Sherburne