President Joe Biden's budget for Fiscal Year 2024 includes a one-third increase in funding to prevent new HIV infections.
The Ending the HIV Epidemic Initiative is seeking a 90% reduction in new HIV infections by 2030. First announced in 2019, the initiative was funded in last year's final budget to the tune of $537 million.
"The budget invests $850 million in the Ending the HIV Epidemic Initiative across HHS to aggressively reduce new HIV cases, increase access to pre-exposure prophylaxis (also known as PrEP), and ensure equitable access to services and support for those living with HIV," Biden's budget proposal, released earlier this month, states, referring to the Health and Human Services Agency.
"The budget also reduces Medicaid costs by eliminating barriers to accessing PrEP for Medicaid beneficiaries and proposes a new mandatory program to: guarantee PrEP at no cost for all uninsured and underinsured individuals," the proposal states.
PrEP refers to the use of antiviral drugs to prevent people exposed to HIV from becoming infected. The pill Truvada was first approved for PrEP use in 2012 by the federal Food and Drug Administration; since then the FDA has also approved the pill Descovy for some groups, and the drug Apretude as an injectable treatment. According to U.S. Centers for Disease Control and Prevention statistics, only 25% of the approximately 1.2 million Americans who could benefit from PrEP had prescriptions in 2020.
The CDC also estimates PrEP use led to an 8% decrease in new HIV infections from 2015-19.
Private insurers are mandated under the Affordable Care Act to provide PrEP services free of charge; but as 22 attorneys general reminded the feds in a letter before Biden's budget was announced, some do charge copays, as the Bay Area Reporter reported. The attorneys general stated in the letter that a new diagnostic code for PrEP should remove any confusion on the matter.
Lisa George, a public affairs specialist with the media relations division of the CDC, stated to the B.A.R., "A full official list of new ICD-10-CM codes and changes, which is still being completed, is scheduled to go into effect in early October 2023."
Medicare does sometimes charge for PrEP, Carl Schmid, a gay man who is the executive director of the HIV+Hepatitis Policy Institute, told the B.A.R. The injectable PrEP is covered under Medicare Part B, and the Centers for Medicare and Medicaid Services has stated it is initiating full coverage for PrEP in pill form, which Schmid said may be covered as soon as in October.
Biden's proposal includes a $90 million increase in HIV prevention programs at the CDC, and $15 million to increase PrEP access and related services at community centers (building atop $157 million already being used for that purpose).
The $850 million also includes an increase of $125 million for the Ryan White HIV/AIDS Program — the federal program for HIV medical care, supportive services and medicine — building atop $165 million.
The budget plan also proposes manifold increases in funding for HIV and hepatitis C prevention activities at the Indian Health Service: from $5 million to $52 million.
Separately, the Biden administration is proposing a PrEP delivery program that would cost $9.7 billion over 10 years.
A five-year, $11 billion program would clamp down on hepatitis C. Unlike hepatitis A and B, there is no vaccine for hepatitis C, which is a bloodborne infection. Until 2014, the drugs interferon and ribavirin were the primary treatments, but now there are antiviral medications available.
The budget plan states that it includes "a new mandatory proposal for a national program to significantly expand screening, testing, treatment, prevention, and monitoring of hepatitis C infections in the United States, with a specific focus on populations with high infection levels. This program would support Federal procurement of life-saving treatments, while bolstering provider capacity and related public health efforts such as testing, communication, and surveillance."
Schmid told the B.A.R. that it's going to be hard for Biden to get his proposals. The amount in last year's final budget had to be scaled back from $850 million and "that was under a Democratic Congress," Schmid said.
Now, the House of Representatives is under Republican control.
"I think it's sufficient," Schmid said about Biden's proposal. "It's a good start. It's not enough because we need other things, including $6 million for AIDS housing at HUD," he said, referring to the U.S. Department of Housing and Urban Development.
Indeed, Mackenzie Flynn, a policy associate with AIDS United, wrote on that group's website that "while the proposed budget included funding for several pivotal programs, such as Ending the HIV Epidemic efforts, a PrEP program, and a new national hepatitis C elimination program, it fell short of many of the HIV community's other priorities, including for the Housing Opportunities for People With HIV/AIDS program and the Minority HIV/AIDS Fund."
Flynn pointed out that the $505 million proposal for the HIV/AIDS housing programs "wouldn't even cover the cost of inflation."
Schmid's institute modeled last year that $6.18 billion would be needed over 10 years to provide the 1.2 million Americans who are eligible for PrEP with the medication. Twenty percent of potential PrEP users are uninsured, according to the institute, and while this includes 17% of whites and 18% of Blacks who could benefit from the medication, it also includes 31% of Latinos, underscoring the need to reach out to focus on historically underserved groups.
"We need increases everywhere," Schmid said. Unfortunately, the PrEP delivery program "will be very difficult to pass even though we need it."
"What we think will be more realistic is funding for the CDC and community health centers to do more PrEP work," Schmid said.
The White House and the office of House Speaker Kevin McCarthy (R-Bakersfield) did not immediately respond to requests for comment for this report as of press time.
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