[argonaut]

Almost all health insurance companies in the USA are required to fully cover PrEP, including Descovy. This doesn't stop health insurance companies from trying to deny you, of course. You would have to appeal the denial all the way up to your state's department for health insurance, but you would definitely win.

EDIT: I was mistaken, this only applies in California.

[chimeracoder]

> Almost all health insurance companies in the USA are required to fully cover PrEP, including Descovy. They aren't even allowed to require that you try (generic) Truvada first before trying Descovy.

They are required to cover PrEP, but that doesn't mean that they are required to cover Descovy specifically. If they cover Truvada and all associated labwork or outpatient visits without any out-of-pocket costs for you, that's sufficient to comply with the law.

> This doesn't stop health insurance companies from trying to deny you, of course. You have to appeal the denial all the way up to your state's department for health insurance, which you will definitely win.

Having helped many people who've been in this exact situation, it's unfortunately not a given that you will win (you have to play your cards exactly right), and most people who need it can't afford to pay over $2000/month for the several months it takes for this to happen[0].

The most likely scenario is that the insurance company wins, because you give up.

[0] The insurance company has something like 30 days to respond for the first appeal, then an additional 45 for the second and third rounds, and that's assuming everything happens on schedule and you respond to everything immediately.

[FireBeyond]

There is also an emerging market for companies that will help you fight health insurers, and I'd have to imagine that they have some playbooks or can develop them for common situations.

And if not, maybe there should be. I saw some ugly shit in my days working for a company that wrote software for some of the bigger insurers.

Hmm.

[argonaut]

You are right, my comment is only valid in California.

[nerdjon]

That… is good to know. I knew they were required but figured generic Truvada was the requirement.

Well kinda irrelevant. My previous insurance loved to deny things, it’s why my company changed.

I worked with my doctor, tried multiple times to get them to cover Descovy (I struggled with the larger pills, I finally just forced myself to get used to it) and was never successful. Just gave up.

[chimeracoder]

See my sibling comment. GP is half-correct. They are not required to cover Descovy specifically. Covering Truvada is sufficient to comply with the law (assuming they are also covering all associated labwork and outpatient visits, and not requiring you to pay anything out-of-pocket for any of those).