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Comment by nerdjon | Hacker News Reader

The problem I think really comes down to there being a generic Truvada.

Insurance for a bit seemed fine with covering Descovy but it seems that is less of a case now since it’s so much more. I would expect the same with a shot like this.

However I would hope that the added benefit of not needing to worry about adhering to taking it every day could outweigh that financial cost for insurance.

I recently switched insurance companies and my new one covers Truvada completely, not even a copay. It’s honestly kinda wild I pay more for my Adderall than I do prep. Obviously I don’t know for sure but I have wondered if it is related to it being preventative and the potential alternative cost makes it smarter to remove any barriers.

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Almost all health insurance companies in the USA are required to fully cover PrEP, including Descovy. This doesn't stop health insurance companies from trying to deny you, of course. You would have to appeal the denial all the way up to your state's department for health insurance, but you would definitely win.

EDIT: I was mistaken, this only applies in California.

That… is good to know. I knew they were required but figured generic Truvada was the requirement.

Well kinda irrelevant. My previous insurance loved to deny things, it’s why my company changed.

I worked with my doctor, tried multiple times to get them to cover Descovy (I struggled with the larger pills, I finally just forced myself to get used to it) and was never successful. Just gave up.

See my sibling comment. GP is half-correct. They are not required to cover Descovy specifically. Covering Truvada is sufficient to comply with the law (assuming they are also covering all associated labwork and outpatient visits, and not requiring you to pay anything out-of-pocket for any of those).

> Almost all health insurance companies in the USA are required to fully cover PrEP, including Descovy. They aren't even allowed to require that you try (generic) Truvada first before trying Descovy.

They are required to cover PrEP, but that doesn't mean that they are required to cover Descovy specifically. If they cover Truvada and all associated labwork or outpatient visits without any out-of-pocket costs for you, that's sufficient to comply with the law.

> This doesn't stop health insurance companies from trying to deny you, of course. You have to appeal the denial all the way up to your state's department for health insurance, which you will definitely win.

Having helped many people who've been in this exact situation, it's unfortunately not a given that you will win (you have to play your cards exactly right), and most people who need it can't afford to pay over $2000/month for the several months it takes for this to happen[0].

The most likely scenario is that the insurance company wins, because you give up.

[0] The insurance company has something like 30 days to respond for the first appeal, then an additional 45 for the second and third rounds, and that's assuming everything happens on schedule and you respond to everything immediately.

You are right, my comment is only valid in California.

There is also an emerging market for companies that will help you fight health insurers, and I'd have to imagine that they have some playbooks or can develop them for common situations.

And if not, maybe there should be. I saw some ugly shit in my days working for a company that wrote software for some of the bigger insurers.

Hmm.

> The problem I think really comes down to there being a generic Truvada.

Truvada has been generic for about six years now.

> I recently switched insurance companies and my new one covers Truvada completely, not even a copay. It’s honestly kinda wild I pay more for my Adderall than I do prep.

That's because under the ACA, insurance companies are legally required to cover PrEP at no out-of-pocket cost, without any cost-sharing, copays, or deductibles applied. This also applies to associated labwork and outpatient office visits.

Unfortunately, many insurance companies ignore this requirement, and it's very difficult as an individual to get them to comply.

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