HIV-prevention and post-exposure medications now available with no out-of-pocket cost to insured

PROVIDENCE — Dozens gathered Wednesday at a clinic specialized in servicing the LGBTQ community in the South Side to watch Rhode Island’s governor sign a bill expanding access to drugs which fight exposure to HIV.

The ceremony focused on S563A, sponsored by Sen. Melissa Murray, a Woonsocket Democrat, which guarantees no out-of-pocket costs to patients covered by health insurance plans for pre-exposure prophylaxis (PReP) and post-exposure prophylaxis (PEP). Both drugs target people at risk of exposure to the Human Immunodeficiency Virus (HIV). The legislation also allows pharmacists to prescribe the drugs to eligible patients.

“These medications are the best tools we have to arrest the spread and work towards the eradication of HIV,” Gov. Dan McKee said before placing his signature on the bill. “This is an important bill and an important step forward.”

“I’m old enough to remember when contracting HIV meant an automatic death sentence,” Murray said. “We should be proud that our state is a national leader on this front.”

PReP, a medication that comes in pill form and injectable form, is meant to be taken before any potential exposure. Since the first PReP drug received approval from the Food and Drug Administration in 2012, it has made a major difference in HIV rates; and patients are flocking to it.

Dr. Philip Chan, chief medical officer for Open Door Health, the Central Street clinic where the signing took place, said the bills allowing no cost injections of PReP will likely increase use of the drugs, as the stigma associated can be reduced. 

“A lot of insurers have put up high cost barriers and prior authorizations,” Chan said. “The purpose and intent of the bill was to make sure there were no out of pocket costs.”

Those costs can be high, with PReP drug Truvada costing up to $2,000 monthly without insurance. As a result, only about 25% of individuals at risk of HIV transmission are using such treatments, according to the US Centers for Disease Control (CDC). 

“We prescribe dozens of prescriptions for these daily,” Chan said. “70% to 80% of HIV infections are still among gay and bisexual men.”

According to data from the Rhode Island Department of Health, newly detected HIV infections in the state dropped from 78 in 2012 to 67 in 2021 — a 14% decrease. 

The same data counted a total of 2,703 HIV positive people living in Rhode Island in 2021, up from 2,286 in 2011, an 18% increase. The rise was attributed to advances in treatment extending patient’s lives as well as migrations to and from the state. 

PEP

Among the major concerns was ensuring rapid access to PEP products within 72 hours of exposure when most studies say the drugs are effective.

PEP covers a number of antiretroviral treatments that have been available since the late 1980s. Chan said PEP treatments must be taken shortly after any potential exposure to be effective. 

“The recommendation is that you need to take PEP within 72 hours,” Chan said. “But the evidence also suggests that as soon as possible is most effective. After 72 hours, the science has not shown any benefits.”

This is a sticking point for some when it comes to the law, as prior authorization requirements may make it difficult for those who need the drug to obtain it; even with provisions in the law to expedite prior authorization.

“I would love to eliminate the pre-authorization and out-of-network requirements,” Sen. Melissa Murray, the bill sponsor, said in an interview. “I’m sure we can go back next year and strengthen this.”

At the end of the day, for Murray, the bill serves its purpose, a step forward in addressing a major public health crisis.

“A cure for a disease cannot be revolutionary unless it is accessible to all,” she said.

Rhode Island joins a growing list of states including Maine, Nevada and Virginia that have passed similar legislation making HIV-prevention and post exposure medications affordable and covered by insurance.