The safety and efficacy of PrEP for HIV prevention are well-established. Even as PrEP access increases, there are legal and policy challenges. Although the FDA recently approved Truvada as PrEP for adolescents, state consent and confidentiality laws remain barriers to adolescents accessing PrEP without parental consent. Confidentiality is a concern for minors and legal adults who are covered by a parent’s health insurance. Health insurers have also imposed barriers to PrEP coverage and have rejected claims for multi-site STI testing and other services required for PrEP care. Insurers have even denied life, long-term care, and other insurance to PrEP users, prompting litigation and allegations of discrimination. Moreover, too many health care providers and individuals at risk for HIV are uninformed about PrEP. Expanding PrEP access has further spurred initiatives to ensure that patients receive accurate and timely information about PrEP. These initiatives may be in tension with a recent Supreme Court case on the First Amendment rights of health care providers. Efforts to make PrEP more convenient and accessible are underway, but raise legal issues. There are promising telehealth models for PrEP. Almost all states reimburse for telehealth under Medicaid and most require private insurers to cover telehealth, but state laws vary widely and only some laws permit reimbursement for telehealth services originating from a patient’s home. Long-acting PrEP, which would not require daily dosing, is in development and will be subject to complex policy decisions from FDA review to different laws for pharmaceutical coverage in public and private insurance.
Speakers: Daniel Bruner (Whitman-Walker Health); Sean Bland (O’Neill Institute for National and Global Health Law, Georgetown University Law Center); Bennett Klein (GLAD – Legal Advocates and Defenders); Naomi Seiler (George Washington University School of Public Health, Department of Health Policy and Management)