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House of Representatives
Session of 2017 - 2018 Regular Session


Posted: March 6, 2017 02:31 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 (Re-Introduction)
In the near future, I plan to re-introduce legislation – House Bills 1879 and 1880 – 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.

As of 2015, the Pennsylvania Department of Health estimates there are 34,961 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.

Document #1

Introduced as HB1107

Description: The first piece of legislation – former House Bill 1879 – would require private insurance companies to cover Pre-Exposure Prophylaxis (PrEP) HIV medication.
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.  According to the Centers for Disease Control and Prevention (CDC), daily PrEP use can lower the risk of getting HIV from sex by more than 90% and from injection drug use by more than 70%.
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

Introduced as HB1112

Description: The second piece of legislation – former House Bill 1880 – would require private insurance companies to cover Post-Exposure Prophylaxis (PEP) HIV medication.
PEP consists of 2-3 antiretroviral medications taken after being potentially exposed to HIV.  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 and is taken over a period of 28 days.  PEP is recommended for individuals who may have been exposed to HIV during sex, while sharing needles or working to prepare drugs, or were sexually assaulted.  Health care workers may also be at risk for possible exposure to HIV, although occupational transmission is extremely rare.
Without insurance, the full 28 day prescription of PEP can cost between $800 and $1,500.  If an individual is prescribed PEP after a sexual assault, they may qualify for reimbursement from the Office for Victims of Crime, United States Department of Justice.  It is also 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 manufacturer.