Should insurance pay for PrEP

[Guest Cutedelicategay]

Moderator's Note: This discussion derailed another thread asking for help finding PrEP in Ontario. It has been moved to its own thread. 

Being in Ottawa I can say that you need either a referral from public health clinic to ID doctor who is a Prep provider. If you have a family doctor ask him or her. In Ottawa there are 2 Prep provider doctors. Most family doctors are reluctant as the duty of care is very high. You have to get tested every 3 months for HIV and other STI. Also chances of acquiring other STI are pretty high given the barebacking intent when on Prep. Family doctors find that too high risk for liability purposes. Truvada is around 900$ for 3 months while generic brand is 500$. There is no insurance from the government and they are right in refusing that since one don't need Prep to stay negative. Condoms does the same thing. Both have to be used correctly though. Since Prep is a choice government should not pay for it. If you can afford private insurance they cover Prep. Try your own or employer insurance. It's not Doug Ford refusing it but it's a choice men make when condoms sufficiently does the same job.

[garsento]

Everyone has a right to appropriate and effective healthcare.

That Ontario lacks the funding for the sort of systematic pharmacare that Québec has speaks poorly of this province.

[drscorpio]

On 7/16/2018 at 3:01 PM, Cutedelicategay said:

 There is no insurance from the government and they are right in refusing that since one don't need Prep to stay negative. Condoms does the same thing. Both have to be used correctly though. Since Prep is a choice government should not pay for it. If you can afford private insurance they cover Prep. Try your own or employer insurance. It's not Doug Ford refusing it but it's a choice men make when condoms sufficiently does the same job.

I'm sorry, but your position is just ignorant. Here is the World Health Organization's official recommendation since 2015:
"In 2014 WHO recommended offering PrEP to men who have sex with men (MSM). On the basis of further evidence of the effectiveness and acceptability of PrEP, WHO has now broadened the recommendation to include all population groups at substantial risk of HIV infection. Offering PrEP should be a priority for populations with an HIV incidence of about 3 per 100 person-years or higher. PrEP should be an additional prevention choice in a comprehensive package of services that also includes HIV testing, counselling, male and female condoms, lubricants, ARV treatment for partners with HIV infection, voluntary medical male circumcision and harm reduction interventions for people who use drugs."

The CDC in the USA has recommended every sexually active gay man with multiple partners be on PrEP. I don't know what to search for in Canada. 

Condoms DO NOT work as well as PrEP. They provide no protection if they break which may be as often as 10-15% of the time with anal sex because they are actually designed for vaginal intercourse. 

[Guest Cutedelicategay]

It seems we Canadians complain when we don't get freebies. Social programs can't run endlessly. They need tax dollars. Canada is wasting tax dollars in refuge board at the expense of other programs. Yes we have right to health care but we do have a responsibility to pay a portion for it. Nothing is free in mordern society. I am an absolute conservative and sorry but liberals and NDP has ruined a lot of Canadian values.

[garsento]

On 7/18/2018 at 10:41 PM, Cutedelicategay said:

Social programs can't run endlessly. They need tax dollars.

This is obvious. PrEP saves money, compared to the costs of HIV treatment.

Can we move back to the subject I tried to start a discussion on?

[Guest Cutedelicategay]

6 hours ago, torcub said:

This is obvious. PrEP saves money, compared to the costs of HIV treatment.

Can we move back to the subject I tried to start a discussion on?

Agreed that prevention is better than cure but without factoring the pubmic health system the discussion will go nowhere. One has the right to health care and take any medication that i good for them to prevent any health issues but you seem to argue that the society should bear the burden of choices and thats where the logic fails. So far hundreds of thousands of people used condoms to prevent HIV. In fact in one of my other posts I have related how guys of Prep still insist on condoms. So the prudent question is if you make a choice for prep then you should pay for it. The government has no incentive in taxing everyone to satisfy the high cost choices of few. Unless there is a health alarm raised condoms do a great job. If condoms break to a certain percent so is prep at 98%. If your intent is to start a political debate then i can understand but if you can think open mindedly you will realize how bad the health care system is. Over the already burdened health care you are adding high level of duty of care that a few doctors who are prep providers will be forced to rethink. I dont see the society agreeing to pay for expensive medicines when alternatives are available. If you dont know but the private insurance companies dont pay for brand medicines if a generic drug is available. 

[drscorpio]

You are being deliberately obtuse. The reason why most insurance covers PrEP in the USA is because it make financial sense to do so. It certainly is not out of any regulation or sense of obligation; insurance here is for profit only. 

A person who contracts HIV is a bigger financial liability for the company. They will have to pay for at least 3 different ant--retroviral drugs for as long as that person lives. The only thing that will relieve them of this financial obligation is the person dying. If the person does not realize they are Poz until after opportunistic infections occur, there is the additional expense of treating those illnesses. 

A person on PrEP is taking a two-drug combo pill. They may take it the rest of their lives, or they may eventually discontinue taking it for any number of reasons. This is a less expensive ption for the insurance company. 

 There is a discussion of these points here, but I found the same information in dozens of places with a quick web search. 

[RotzBBengel]

Earlier this week, our Secretary of Health over here in Germany announced that he's going to launch a law to make all insurances pay for PrEP - at least if you belong to one of the "high-risk" groups. Must be because the guy is openly gay himself - he probably has a different view on this topic than his predecessors in office had...

Well, let's see what cums...uh...comes of it...if anything at all...

[6811283]

On 7/20/2018 at 7:25 AM, Cutedelicategay said:

 you seem to argue that the society should bear the burden of choices and thats where the logic fails. So far hundreds of thousands of people used condoms to prevent HIV. 

People make choices all the time that have consequences for healthcare costs that are borne by society -- including dietary and exercise habits and, yes, sex. Human beings are not machines, and powerful natural drives like eating and sex are not easily governed rationally.

Yes, many people have successfully prevented HIV by using condoms. Many others have not, despite their best intentions. In the US, although we have known for almost 40 years that we "should" use condoms, until recently the number of new HIV cases remained stubbornly at about 40,000 a year. Because human nature is what it is, we had reached the limit of the effectiveness of condoms as a public health measure. Simply shouting the same message louder and louder isn't going to change that.

Prep is a revolutionary change, another prevention tool that is finally making some progress and could help break the back of the epidemic. In cities and states where Prep has been broadly introduced, HIV rates are dropping sharply -- while they continue to rise among populations that don't have access to Prep.

This isn't just about individuals and whether they should pay for their own choices. This is about effective public health measures to end a devastating and expensive communicable disease. That is everyone's business.

https://www.pharmacypracticenews.com/Web-Only/Article/07-18/Truvada-for-PrEP-Led-to-Significant-Declines-in-New-HIV-Infections/52277

[mort]

People do not see the bigger picture all this talk about get every one on pRep they will be protected well yes for now for HIV they may be but what about all the other std/sti if you are basically saying its safe to bareback now more people will do it so you then get even more rise in the other problems (the argument about people on pRep get tested more doesn't hold up because if every one is on it that means more spread so more treatments with antibiotics are used so then they will become useless opening up another big problem not just for sti/std)

 

The other issues are if so many people take it and it then becomes useless there is gong to be a big problem and people keep ignoring that not every one can take it plus there is many cases which is has caused health issues.

 

Insurance shouldn't cover this it's about time we stop letting the Pharm/insurance set these silly prices this drug could easily be produced for a few $ for months supplies which people can go and buy from your local pharmacies health care shouldn't be about profit.

[tightpussyboy]

i don't think insurance should pay for any treatement, prep or hiv drugs. if you cant afford it out of pocket, well...best of luck.

[6811283]

On 7/30/2018 at 8:05 PM, tightpussyboy said:

i don't think insurance should pay for any treatement, prep or hiv drugs. if you cant afford it out of pocket, well...best of luck.

Well isn't that nice, Ayn Rand.

Society has an interest in helping prevent and treat communicable diseases because they don't just affect individuals, when they spread rampantly they affect the whole country. Before effective ARV treatments came along, there were entire African countries on the brink of collapse because productive adults in their prime were dropping like flies. Nobody told all those people it was their individual problem.

[rawloadstaken]

On 7/30/2018 at 5:05 PM, tightpussyboy said:

i don't think insurance should pay for any treatement, prep or hiv drugs. if you cant afford it out of pocket, well...best of luck.

Out of curiosity -- and I truly mean that, I'm not trying to be a sh*t-stirrer -- do you feel the same way about cancer medications, psych meds, antibiotics, blood pressure medications, muscle relaxants, physical therapy, corrective lenses, mobility devices, or guide dogs?

In a number of these cases -- much like in cases where individuals are walking the tightrope of potential seroconversion -- there is a benefit to providing care and/or corrective assistance; and, when and where possible, prevention in general costs far less for both insurance companies and society as a whole than does treatment.

That said, in some cases where prevention is not possible -- prostate cancer, for example -- this particular equation doesn't apply; however, when it comes to issues such as a non-zero incidence of self-inflicted lung cancers, "all anyone has to do" is to never associate with smokers in case of second-hand smoke, and never smoke themselves. If they choose to violate these two simple rules and eventually face lung, chest, mouth, or throat cancer, then a logical extrapolation of your policy would be that any treatment related to any of these issues -- pneumonia, degradation of the soft palate, pleurisy, oropharyngeal cancer, lung abscesses, erosion of the larynx, bronchitis, or tuberculosis, just to name a few -- should not be covered by insurance, and if the individual in question cannot afford the treatments, well then, they're out of luck.

For a non-zero number of cases -- not most, let alone all, but some -- certain skin cancers, HPV, Syphilis, Cirrhosis of the Liver, calcium-related Kidney Stones, and diabetes are preventable. With these conditions , do you object to insurance covering any cryotherapy, as some people could avoid many skin cancers by never going outdoors? What about any HPV vaccinations, as some people could avoid contracting many STis by not having sex? Do you object to insurance covering any insulin, as some people could avoid the risk of becoming diabetic by cutting sugars out of their diet?

The list goes on: what should, and what shouldn't, be covered, and where is the cutoff?

Bringing this back around to the original point, some non-medicated, HVL HIV-positive individuals are otherwise healthy, and some non-medicated HVL HIV-positive individuals deal with health issues. With that in mind, should any HIV-positive individual who needs assistance be prevented from using ambulances to get to the ER, the ER visits, the blood work, potential CT scans, and IV fluids and medications because they cannot pay for it out of pocket, or should society -- by means of insurance -- help those who are less fortunate or have pre-existing conditions which preclude them from paying thousands, if not tens of thousands, of dollars out of pocket and passing away as a result?

Again, I'm not trying to be combative; however, some individuals both online and in my personal meatspace do not seem to see the dichotomy between saying issue [a] is wrong but issue is right, and yet they both address the same underlying concern: in this case, should insurance cover a condition that may or may not be preventable, and is prevention less costly than treatment?

Edited August 14, 2018 by rawloadstaken
Removing bold text formatting