The U.S. Preventive Services Task Force’s decision on Tuesday to expand the list of PrEP drugs it recommends to reduce the risk of HIV transmission has public health advocates feeling optimistic. Increased uptake of PrEP medicines could significantly reduce transmission, but many of those at risk aren’t taking them. The newly recommended Apretude from British drugmaker ViiV Healthcare is an injectable that patients only need to take every other month. The other option, which the task force recommended in 2019, is a daily pill: Descovy from Gilead Sciences. There’s evidence that long-acting injectable PrEP is more effective than the daily pill, because of spotty adherence. The task force's recommendation triggers Obamacare's coverage mandate, so patients with insurance can get the drugs without a copay or deductible. “You may not want to take a drug every single day,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “I think the future of PrEP is going to be long-acting.” The task force’s decision to approve the injectable “offers clinicians more opportunities to give people options that will work with their own lifestyle,” added Dr. Jim Stevermer, a task force member and professor of family and community medicine at the University of Missouri. Why it matters: While PrEP uptake has improved in recent years, growing from 13 percent of those that could benefit in 2017 to 30 percent in 2021, according to the CDC, progress has been uneven: 78 percent of eligible white people are taking PrEP, compared to only 21 percent of eligible Latino people, 11 percent of eligible Black people and 12 percent of eligible women. Even so: A federal district court in Texas in March tossed out Obamacare’s preventive care insurance requirement, siding with a group of Texas employers and individuals that claim the mandate is unconstitutional because the task force is made up of independent experts who are neither Senate-confirmed nor chosen by a Senate-confirmed agency head. The plaintiffs also singled out PrEP, arguing that requiring coverage of it violates their religious rights. The 5th U.S. Circuit Court of Appeals has stayed the ruling while it considers the Biden administration’s appeal. What’s next? If the preventive care insurance mandate stands, insurers will have to cover the newly recommended PrEP option in the plan year starting on or after Aug. 31, 2024.
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