Chicago — Attorney General Kwame Raoul, as part of a coalition of 21 attorneys general, today submitted a letter to the Centers for Disease Control and Prevention (CDC) and the National Center for Health Statistics advocating for clear classification of HIV prevention medication to prevent improperly charged medical copays.
In the letter, Raoul and the coalition support creating a new diagnostic code for Pre-exposure Prophylaxis (PrEP) for HIV prevention in the International Classification of Diseases – Tenth Revision (ICD-10). Raoul and the coalition argue the implementation of a new code will ensure lifesaving access to PrEP and related medical services for populations vulnerable to HIV/AIDS.
“Inconsistent and unclear coding should not stand in the way of people from being able to access affordable HIV preventative medication,” Raoul said. “I will continue to advocate for policies that ensure HIV preventative medication is available and covered without out-of-pocket costs to patients.”
PrEP is a form of antiretroviral therapy used to prevent the transmission of HIV for those who are at risk of exposure to the virus through sex or injection drug use. The U.S. Food and Drug Administration has approved three PrEP drugs, Truvada, Descovy and Apretude. Since 2020, federal law requires that most health plans cover at least one form of PrEP and all related services, including laboratory testing and appointments, without any cost to the patient.
Currently, there is no specific ICD-10 diagnosis code for PrEP, which leaves providers with fewer available code options. As a result, insurers and providers often choose a code that does not actually apply to PrEP, which makes it difficult for providers to indicate the service is preventative and should be covered without cost sharing.
For example, a patient hoping to receive PrEP might be required to take a pregnancy test prior to prescription. Without an ICD-10 code to indicate the pregnancy test is for PrEP and therefore preventative, there is no way to ensure the service is billed properly across providers or consistently covered by insurers. Creating a new code will solve this problem.
If patients cannot afford PrEP and are deterred from seeking care, Raoul warned in the letter that there may be dire results.
Attorney General Raoul joined attorneys general of California, Colorado, Connecticut, Delaware, the District of Columbia, Hawaii, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New York, Oregon, Pennsylvania, Rhode Island, Vermont, Washington and Wisconsin in signing the letter.
