October 08, 2020
GOVERNOR CUOMO ANNOUNCES DFS ISSUES GUIDANCE TO INSURANCE INDUSTRY CLARIFYING COVERAGE FOR Prep AND RELATED SERVICES
Prohibits Cost-Sharing for PrEP and Related Services for Consumers
Circular Letter Developed in Collaboration with Insurance Industry
Governor Andrew M. Cuomo today announced the Department of Financial Services has issued a Circular Letter to New York-regulated health insurers, clarifying coverage for pre-exposure prophylaxis, known as PrEP, for the prevention of HIV infection and related services.
"As the Trump administration continues to scale back access to healthcare and provide unclear guidance during a pandemic, New York will use our full authority to provide New Yorkers the healthcare they deserve, regardless of sexual orientation or gender expression, or transgender status," Governor Cuomo said. "This guidance is clear - New Yorkers have access to PrEP coverage and related services without cost-sharing."
New York State Superintendent of Financial Services Linda A. Lacewell said, "As the federal government continues to dismantle access to quality healthcare, DFS will continue to uphold critical health coverage for consumers, regardless of their sexual orientation, gender identity, or transgender status, in collaboration with industry. New York-regulated health insurers must provide coverage for PrEP with no cost-sharing, including recommended tests and services associated with PrEP."
The USPSTF Final Recommendation Summary for PrEP, in the section on "Other Considerations, Implementation," also recommends that certain tests and services be provided to a person at high risk of HIV acquisition prior to prescribing PrEP or as ongoing follow-up and monitoring.
The Circular Letter issued today clarifies that, in the absence of federal guidance to the contrary, New York-regulated health insurers, except for grandfathered health plans, are required to cover any associated tests and services that are also recommended by the USPSTF with no cost-sharing.
Recognizing the importance of PrEP coverage for the prevention of HIV infection, DFS collaborated with the insurance industry to ensure that PrEP and related services are available to New Yorkers who need them.
It is critical that people who may benefit from PrEP be able to access and afford testing and follow-up services, regardless of sexual orientation, gender identity, or transgender status, and DFS will act to ensure full compliance with today's Circular Letter, Insurance Circular Letter No. 21 (2017), and Supplement No.1 to Insurance Circular Letter No. 21 (2019).