How Rising Insurance Premiums Are Impacting Access to PrEP

Pre-exposure prophylaxis (PrEP) has been one of the most effective public health tools in the fight against HIV. When taken consistently, PrEP reduces the risk of acquiring HIV by up to 99%. Yet despite its proven effectiveness, access to PrEP is becoming more difficult for many people—and a major reason is the steady rise in insurance premiums and related out-of-pocket costs.

The Promise of PrEP—and the Cost Barrier

PrEP was designed to be a preventive solution, helping individuals stay HIV-negative and reducing long-term healthcare costs overall. In theory, many insurance plans cover PrEP, especially since U.S. guidelines recommend it as a preventive service. In practice, however, rising insurance premiums, high deductibles, and cost-sharing requirements are creating new barriers.

For many people, simply maintaining insurance coverage is becoming unaffordable. Higher monthly premiums mean some individuals downgrade their plans, lose coverage altogether, or avoid using healthcare services—even preventive ones like PrEP—to save money.

Deductibles, Copays, and Hidden Costs

Even when PrEP medication itself is covered, other associated costs often are not fully paid for:

• Doctor visits required every three months

• Lab tests for HIV, kidney function, and STIs

• Copays or coinsurance tied to specialist visits

As insurance premiums rise, these out-of-pocket costs often rise too. For people living paycheck to paycheck, these recurring expenses can make staying on PrEP financially unsustainable.

Disproportionate Impact on Vulnerable Communities

Rising insurance costs hit hardest in communities already most affected by HIV—including LGBTQ+ individuals, Black and Latino communities, young adults, and people with lower incomes. These groups are more likely to work in jobs without robust health benefits or to rely on high-deductible marketplace plans.

When premiums increase, people may delay refilling prescriptions, skip follow-up appointments, or stop taking PrEP altogether. This not only increases individual risk but also undermines broader public health efforts to reduce new HIV infections.

The Public Health Consequences

Reduced access to PrEP doesn’t just affect individuals—it affects everyone. When fewer people can afford PrEP, HIV transmission rates risk increasing, leading to higher long-term healthcare costs for treatment and care. Preventing HIV is far more cost-effective than treating it, but rising insurance premiums push the system in the opposite direction.

Conclusion

PrEP remains a powerful tool in ending the HIV epidemic, but its effectiveness depends on consistent and affordable access. As insurance premiums continue to rise, more people are being priced out of prevention. Addressing insurance affordability isn’t just a financial issue—it’s a public health imperative.

Ensuring that PrEP is accessible to everyone who needs it is not only the right thing to do, it’s one of the smartest investments we can make in a healthier future.