Trump Administration Announces Free HIV-Prevention Medication for Uninsured Americans

Today, the U.S. Department of Health and Human Services announced a plan to make HIV prevention medication free to people without insurance.

Pre-exposure prophylaxis, or PrEP, is the lone prevention treatment for people susceptible to HIV infection, but it's notoriously expensive in the United States, especially for people on high-deductible health plans or without insurance.

It's phase one of President Donald Trump's strategy to end the United States' HIV epidemic by 2030. Starting no later than March 2020, people can obtain the PrEP medications at more than 21,000 combined CVS Health, Walgreens and Rite Aid locations—companies that donated their services in "recognizing the importance" of expanded PrEP access, HHS officials said in Tuesday's press release.

More than 38,000 Americans were newly infected with HIV last year, but "only a small percentage" of people susceptible to the virus use PrEP, according to a 2018 analysis by the Centers for Disease Control and Prevention (CDC).

In a call with reporters, HHS Secretary Alex Azar said the plan will be understood as one of the major public health initiatives of the 21st century. The department estimates that somewhere south of 200,000 people each year, who are susceptible to HIV infection and uninsured, could benefit from the program.

Gilead Sciences is supplying the medication as part of its March agreement with HHS despite its ongoing legal disputes with the federal health wing. Now until 2030, the company is donating enough medication to supply 200,000 individuals annually, which covers the potential reach of the HHS program.

In November, HHS sued Gilead for infringing on U.S. patents related to PrEP. The company sells the only FDA-approved PrEP regimen at the lofty sticker price of $20,000 per year, according to the HHS announcement at the time.

Trump Announces Free PrEP
Senator Mitt Romney (R-UT) listens while US President Donald Trump and US Secretary of Health and Human Services Alex Azar during a meeting in the Cabinet Room of the White House about vaping November 22, 2019, in Washington, DC. Brendan Smialowski/Getty Images

To qualify for the program, patients must test negative for HIV through a lab test they will likely have to pay for. They also need a prescription from a doctor.

Without insurance, a visit to a primary care doctor is about $160, with some variation among states, according to a 2015 survey published by the Johns Hopkins Bloomberg School of Public Health. People can find out if they qualify by visiting or calling toll-free 855-447-8410, HHS said.

For people with insurance, but subject to high deductibles, PrEP could remain too costly until about 2030, when Azar said the drugs are eligible for generic copies in the U.S., and will therefore become cheaper.

The CDC estimates that more than 1 million Americans are at-risk for HIV, but only 90,000 total PrEP prescriptions were filled in commercial pharmacies in 2015.

In the same year, 500,000 black residents and 300,000 Latino residents could have benefited from the treatment, but only 7,000 and 7,600 prescriptions were filled by retail pharmacies and mail-order services, respectively, the CDC said. For white people, 300,000 could have benefited, but just 42,000 prescriptions were filled.

"PrEP is highly effective in preventing HIV infection when taken as directed," said Brett P. Giroir, the acting commissioner of the U.S. Food and Drug Administration (FDA), in a statement. "It is a critical tool for ending the HIV epidemic, but to make an impact it has to be available for people who need it most."