Sec. 2. Findings; sense of Congress

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Congress finds as follows: The Centers for Disease Control and Prevention estimates that approximately 1,100,000 people in the United States are living with HIV. In 2019, there were 36,398 new diagnoses of HIV in the United States. HIV disproportionately impacts gay and bisexual men, transgender women, and, in particular, people of color. For example, in 2019, approximately 66 percent of new HIV diagnoses were among gay and bisexual men, 42 percent of new HIV diagnoses were among Black people, and 22 percent of new HIV diagnoses were among Latinx people.

Recent studies suggest that transgender women are up to 49 times more likely to be diagnosed with HIV than the general population. Members of communities at the intersections of these groups are most heavily impacted. Pre-exposure prophylaxis (referred to in this section as PrEP ) is a daily antiretroviral medication that helps prevent individuals from acquiring HIV. Daily PrEP use reduces the risk of getting HIV from sex by about 99 percent. It reduces the risk of getting HIV from injection drug use by at least 74 percent.

Many individuals at risk of exposure to HIV do not use PrEP. Of the approximately 1,100,000 people in the United States who could benefit from PrEP, only 23 percent, or nearly 285,000 individuals, filled prescriptions for the drug in 2019. PrEP usage is inconsistent across racial and gender lines. In 2019, only 8 percent of Black/African American and 14 percent of Hispanic/Latinx persons who were eligible for PrEP were prescribed it, compared to 63 percent of White persons. Additionally, slightly less than 10 percent of women eligible for PrEP received a prescription in 2019.

There are currently 2 brand name drugs and 1 generic drug approved by the Food and Drug Administration for the use of PrEP on a daily basis. Other types of HIV prevention treatments, including a long-acting injectable, which is currently under FDA review, and long-acting oral pills, implants, and vaginal rings are in the research pipeline. These new innovations can increase widespread use of PrEP along with adherence, which can speed the Nation’s goal to end HIV and address inequities in health care.

Section 2713 of the Public Health Service Act ( 42 U.S.C. 300gg–13 ) requires most private health insurance plans to cover preventive services without cost-sharing, including such services with a rating of A or B under recommendations of the United States Preventive Services Task Force. On June 11, 2019, the United States Preventive Services Task Force issued a final recommendation giving an A grade for PrEP for individuals at high risk of HIV; non-grandfathered private health insurance plans have to cover PrEP for such individuals without cost-sharing effective January 2021.

Joint guidance issued by the Department of Labor, the Department of Health and Human Services, and the Department of the Treasury on July 19, 2021, clarifies that ancillary services necessary to maintain the PrEP regime, including subsequent provider visits, clinical testing, and other services, is required to be covered by health insurers without cost-sharing. Permanently expanding access to cost-free PrEP and ancillary services for all individuals, including individuals who do not have health insurance, through legislation, is a critical step towards eliminating HIV transmission.

Post-exposure prophylaxis (referred to in this section as PEP ) is a daily antiretroviral treatment which, when initiated promptly after a sexual or other exposure to blood or body fluids that is associated with a high risk of HIV transmission, is highly effective at preventing HIV infection. The Centers for Disease Control and Prevention recommends PEP for an individual who has experienced a high-risk exposure incident, provided that the individual tests HIV-negative, initiates such treatment no later than 72 hours after exposure, and continues the treatment for 28 days.

Despite PEP’s proven effectiveness in preventing HIV infection after high-risk sexual exposures, awareness of PEP is low among individuals who would benefit from the treatment. Studies suggest that awareness of PEP and of the importance of its prompt initiation is particularly low among young gay and bisexual men of color, transgender persons, and women of all gender identities. Adequate knowledge of guidelines issued by the Centers for Disease Control and Prevention for assessing indications for PEP and for initiating and sustaining PEP are low among health care providers and staff.

Because PEP is an emergency intervention, insufficient knowledge among providers and staff in hospital emergency rooms, urgent care centers, community health centers, and primary care physicians is of particular concern. Private and public health insurance plans and programs frequently impose requirements for coverage of PEP, including pre-authorization requirements and requirements to obtain the medications through designated specialty pharmacies and mail-order programs that pose significant obstacles to timely initiation of treatment.

Insurance deductibles and co-payments for PEP medications create significant barriers to PEP utilization by many individuals who have experienced high-risk incidents. It is the sense of Congress that the Department of Labor, the Department of Health and Human Services, and the Department of the Treasury should ensure compliance with the requirements described in paragraphs

(8)and

(9)of subsection (a).

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42 USC 300gg–13

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Sec. 2

Findings; sense of Congress

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