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House of Representatives
Session of 2015 - 2016 Regular Session

MEMORANDUM

Posted:	December 22, 2015 01:05 PM
From:	Representative Brian Sims
To:	All House members
Subject:	Insurance Coverage for Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP) HIV Medication Package

In the near future, I plan to introduce legislation that would require private insurance companies to cover Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP) HIV medication. This package is designed to help in the battle against HIV/AIDS and would provide Pennsylvanians with access to medication that they may otherwise be unable to afford. I am introducing this legislation as companion bills to legislation already introduced by Senator Christine Tartaglione. As of 2014, the Pennsylvania Department of Health estimates there are 35,033 active cases of HIV/AIDS in Pennsylvania, with most concentrated in the urban areas of Philadelphia and Pittsburgh. In 2009, the Centers for Disease Control and Prevention’s (CDC) HIV Surveillance Report estimated that the total lifetime treatment costs for HIV in Pennsylvania was $637 million, with Medicaid covering much of the cost. Please consider joining me in sponsoring this life-saving legislation.

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Document #1

Description:

The first piece of legislation would require private insurance companies to cover Pre-Exposure Prophylaxis (PrEP) HIV medication.  This is a companion bill to Senate Bill 1085, Printer’s Number 1470 which was introduced by Senator Christine Tartaglione.    PrEP HIV medication is an important new HIV prevention tool that can save lives, reduce suffering, and has the potential to significantly reduce health care costs associated with HIV and AIDS in the Commonwealth.  This medication, when taken every day, can provide protection against HIV infection for high-risk individuals.  The CDC reports that HIV PrEP medication has been found to reduce the risk of HIV infection by up to 92 percent.  A recent study published in Clinical Infectious Diseases found that none of the study participants developed HIV infections while taking HIV PrEP medication.   Although most private insurance companies provide coverage for PrEP HIV medication, they are not required to do so under current Pennsylvania law, leaving individuals the burden of shouldering the full cost with limited assistance.  The most common PrEP HIV medication, Truvada, costs between $1,300 and $1,500 per month, putting it out of the reach of most Pennsylvanians.

Document #2

Description:

The second piece of legislation would require private insurance companies to cover Post-Exposure Prophylaxis (PEP) HIV medication.  This is a companion bill to Senate Bill 1084, Printer’s Number 1469 which was introduced by Senator Christine Tartaglione.    PEP consists of 2-3 antiretroviral medications taken for a period of 28 days.  In order to be effective, PEP treatment needs to commence within 72 hours of initial exposure to help prevent HIV from copying itself and spreading throughout the body.  Healthcare workers are evaluated for PEP if they are exposed after: getting cut or stuck with a needle that was used to draw blood from a person who may have HIV; getting blood or other body fluids that may contain HIV in their eyes or mouth; or being exposed to blood or other body fluids that may contain HIV through contact with their skin when it is chapped, scraped, or affected by certain rashes.  Additionally, PEP can be taken by individuals who suspect they have been exposed to HIV infection through unprotected sex, intravenous drug use, or sexual assault.   Healthcare workers who are exposed to HIV on the job will usually have PEP covered by their workplace health insurance or workers’ compensation.  If a person is prescribed PEP as a result of a sexual assault, they might qualify for partial or total reimbursement for medications and clinical care costs through the Office for Victims of Crime funded by the U.S. Department of Justice. However, if a non-occupational exposure occurs, individuals must pay the full cost if their insurance does not cover PEP.  Without insurance, the full 28 day prescription of PEP can cost between $800 and $1,500.  It is important to note that if a person is prescribed PEP for another reason, and does not qualify for insurance coverage, their healthcare provider can apply for free antiretroviral medications through the patient assistance programs of the drug’s manufacturers.