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Providers, advocates and regulators outline PrEP access barriers; insurers propose technical edits
Summary
At the Committee on Health hearing, clinicians and advocacy groups described prior authorization delays, cost sharing and 7–15 day turnaround for injectable PrEP approvals; DISB recommended drafting language changes to avoid unintended premium‑setting effects while supporting the bill's intent.
Health providers, advocacy groups and insurers told the committee Oct. 30 that insurance practices such as prior authorization, step therapy and cost sharing can delay or deter access to PrEP and long‑acting injectable prevention. Jay Maurice McCance Purcell (Vive Healthcare) recommended adding a statutory definition of "medically unnecessary restrictions" to include prior authorization and step therapy. Carl Schmidt of the HIV & Hepatitis Policy Institute urged coverage for all FDA‑approved PrEP options rather than relying only on CDC guidance.
Clinics described operational delays: Whitman‑Walker Health said early data indicate 7–15 day delays in approvals for injectable PrEP and that dedicated staff are often needed to manage prior authorization workflows. "People who want to protect themselves against HIV should not face unnecessary delays," said a witness. Tom Glassick of the DC Insurance Federation said most plans in the District already cover PrEP but cautioned about how the bill's language could interact with ACA rate‑setting and underwriting rules; he suggested edits such as removing references to "setting premium rates" and using underwriting/rate‑making terminology instead. DISB said it found carriers covering PrEP in major medical plans but will follow up with the committee about whether cost sharing occurs in some plan variants and whether the department has received complaints.
