A federal appeals court on Friday found unconstitutional a key component of the Affordable Care Act that grants a health task force the effective authority to require that insurers both cover an array of preventive health interventions and screenings and refrain from imposing out-of-pocket costs for them. The lawsuit centered on the objections of a coalition of small businesses in Texas to the requirement that they cover a drug for HIV prevention, known as PrEP, in their employee health plans.
How would this change insurance for PrEP? In 2019, the task force issued an A rating for the drug Truvada as PrEP. Consequently, almost all insurers were required by the ACA to cover PrEP with no cost-sharing by 2021. The Centers for Medicare and Medicaid Services later announced that insurers also could not impose out-of-pocket expenses for the quarterly clinic visits and lab tests required for PrEP users. Even prior to 2021, PrEP was widely covered by insurance.
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