On World AIDS Day, Governor Cuomo Announces New HIV Diagnoses Fall to Record Low and New Actions to Prevent Discrimination and Ensure Insurance Coverage of HIV-Prevention Medication Prep
On World AIDS Day, Governor
"Once the epicenter of the HIV/AIDS crisis, we have made tremendous progress toward mitigating the impact of the disease in
Commissioner of Health Dr.
Financial Services Superintendent
In 2016, there were 2,881 new HIV diagnoses in
Groups disproportionately impacted by HIV all experienced decreases in new infections as well. New diagnoses among gay, bisexual, and other men who have sex with men fell 12 percent between 2015 and 2016 (1,804 to 1,580), the second straight annual decrease after virtually no change in over a decade. New diagnoses decreased in every age group, with the largest decline, 20 percent, among young people aged 20-24 (505 to 406). HIV in communities of color is down significantly as well. Decreases occurred among white, non-Hispanics (11 percent), black non-Hispanics (7 percent), Hispanics (11 percent), and persons with multi-racial backgrounds (23 percent).
In order to prevent new HIV infections in the future and continue
In the guidance issued today, DFS notes that, when imposing prior authorization requirements on PrEP, insurers must carefully consider whether any such requirement would create an unacceptable barrier to coverage for individuals who would otherwise benefit from the medication. Similarly, when performing prior authorization, concurrent or retrospective utilization review for PrEP, insurers and their utilization review agents must comply with the requirement of New York Insurance Law to use appropriate written clinical review criteria when reviewing for medical necessity. In addition, when making coverage determinations, insurers and their utilization review agents must do so in a non-discriminatory manner.
In the event that an insurer denies coverage for PrEP and deems that it is not medically necessary for a particular individual, the insured has the right to appeal. Any denials of coverage must include information set forth in New York Insurance Law, including the reason and clinical rationale for the denial; instructions on how the insured can appeal the decision; and any additional information necessary to render a decision on the appeal.
A copy of the circular letter can be found here (https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/DFS_Circular_Letter.pdf).
Guillermo ChacAln, President,
Today's announcements build on
* Identifying persons with HIV who remain undiagnosed and linking them to health care;
* Linking and retaining persons diagnosed with HIV to health care and getting them on anti-HIV therapy to maximize HIV virus suppression;
* And providing access to Pre-Exposure Prophylaxis (PrEP) for high-risk persons to keep them HIV negative.
Since the 2014 announcement,
New initiatives being launched will set a goal of zero AIDS mortality and zero HIV transmission through injection drug use by the end of 2020.
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