March 10, 2023

Democratic AGs Ask CDC to Help Ensure Access to No-Cost HIV Prevention Drugs

Bernard Nash

Cozen O'Connor

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Cozen O'Connor

A group of 22 Democratic AGs submitted a letter to the CDC and the National Center for Health Statistics (NCHS) urging the agencies to ensure patients are not improperly charged copays for HIV prevention services by creating a new diagnostic code for PrEP (a form of antiretroviral therapy used to prevent transmission of HIV) in the International Classification of Diseases – Tenth Revision (ICD-10).
According to the letter, the Affordable Care Act mandates that preventative services should be covered at no cost to patients, yet several signatory states have received complaints from residents who were charged copays for PrEP-related services. The AGs argue that free access to PrEP is important to ensure the health and wellbeing of their constituents, as some patients have reported testing positive for HIV after stopping PrEP treatment due to financial constraints.
The AGs ask the CDC and the NCHS to establish a specific ICD-10 code for PrEP in order to achieve clarity between providers and insurers regarding PrEP-related services. Currently, providers do not have a specific code to use for services related to the drugs, which creates a lack of consistency among provider coding and uncertainty regarding coverage by insurers.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.