Policy Resolution HHS-25-15

WHEREAS, HIV remains an epidemic with an estimated 1.2 million people living with HIV and 31,800 new HIV diagnoses in 2022 in the United States;

WHEREAS, HIV is a preventable disease that continues to disproportionately impact specific communities including, Black and Hispanic/Latino populations according to the U.S. Department of Health and Human Services;

WHEREAS, in 2022, the Black female population had an HIV diagnosis rate 8 times higher than the White female population, and the Black male population had an HIV diagnosis rate 8 times higher than the white male population according to the U.S. Department of Health and Human Services;

WHEREAS, PrEP is a highly effective tool (daily pill or long acting injectable) for preventing HIV and reduces the likelihood of acquiring HIV from sex by nearly 100 percent and from injection drug use by 74 percent, but as of 2022 was only prescribed to 36 percent of people who could benefit, far below the national Ending the HIV Epidemic Initiative goal of 50 percent according to the Centers for Disease Control and Prevention (CDC);

WHEREAS, Black and Hispanic/Latino communities have disproportionately low rates of PrEP uptake due to lack of awareness and additional barriers faced by these communities;

WHEREAS, Black people comprised over 40 percent of new HIV diagnoses but only 14 percent of PrEP users, and Hispanic/Latino people comprised 27 percent of new HIV diagnoses but only 17 percent of PrEP users according to Emory University;

WHEREAS, Section 2713 of the Patient Protection and Affordable Care Act (ACA) mandates that private health plans provide coverage without any cost sharing of all preventive services with Grade “A” and “B” Recommendations from the US Preventive Services Task Force (USPSTF);

WHEREAS, the ACA mandate encompasses PrEP and ancillary services which received a USPSTF Grade “A” Recommendation in 2019 and an updated Grade “A” Recommendation in 2023 to specifically include long-acting PrEP;

WHEREAS, despite the ACA mandate, some noncompliant insurers continue to charge cost sharing for PrEP and ancillary services creating an additional barrier that may impact certain populations, including Black, and Hispanic/Latino people who could benefit from PrEP; and

WHEREAS, in addition to insurer noncompliance, the ACA mandate is at risk of being overturned due to a decision issued by the United States Court of Appeals for the Fifth Circuit in Braidwood Management, Inc. et al. v. Xavier Becerra et al  and potential future litigation that could allow for private health plans to charge cost-sharing for PrEP and other preventive services.

THEREFORE, BE IT RESOLVED, that the National Black Caucus of State Legislators (NBCSL) supports broad, equitable access to HIV PrEP without cost sharing for patients;

BE IT FURTHER RESOLVED, that the NBCSL, urges state legislatures to enact state legislation that prohibits health plans from charging cost sharing for preventive services with USPSTF Grade “A” or “B” Recommendations;

BE IT FURTHER RESOLVED, that the NBCSL urges state legislatures to limit prior authorization requirements for preventive services, including PrEP, and urges state legislators to work with state insurance regulators to monitor and enforce private health plan compliance with the ACA preventive services zero cost share mandate; and

BE IT FINALLY RESOLVED, that the NBCSL urges state legislators, executives, and public health officials to promote PrEP uptake among populations disproportionately affected by the HIV epidemic through education, outreach, and integration of PrEP in health care settings.

• Resolution ID: HHS-25-15
• Sponsored by: Rep. Venton Jones (TX) and Rep. Toni Rose (TX)
• Policy Committee: Health and Human Services (HHS)