Mississippi’s largest private health insurer updates guidelines for HIV prevention medication
By Gwen Dilworth | Originally published by Mississippi Today
Blue Cross and Blue Shield of Mississippi has updated its guidelines for HIV prevention medication after a national advocacy group alleged the insurer’s coverage options violated federal law.
Cayla Mangrum, director of corporate communications for Blue Cross, told Mississippi Today the company expanded its formulary Thursday to include two HIV prevention drugs: Descovy, a daily oral pill, and Apretude, a long-acting injectable medication administered every two months.
“We simply added Descovy and Apretude to avoid any perception they were not covered,” Mangrum said to Mississippi Today. She said the change is not a shift in coverage because providers could previously request coverage based on medical necessity through an exceptions process.
Healthcare providers told Mississippi Today they have struggled to prescribe these medications to patients with Blue Cross insurance compared to people covered by other insurers. They often have needed to submit letters or ask company leadership for special approval to obtain them. Blue Cross is the largest private insurer in the state, with a market share of 45%.
In a June 1 letter to State Insurance Commissioner Mike Chaney, Washington-based HIV and Hepatitis Policy Institute claimed Blue Cross unlawfully restricted access to several forms of pre-exposure prophylaxis, a highly effective HIV prevention medication known as PrEP. Federal law requires most health insurers to provide beneficiaries access to oral and injectable forms of PrEP with no cost-sharing and without imposing barriers to steer patients to one medication option over another.
“BCBSMS’ coverage of PrEP medications plainly violates these PrEP coverage requirements,” executive director Carl Schmid wrote.
A Blue Cross webpage that previously stated Apretude, a form of PrEP most insurers are required to cover, was “not medically necessary” under the plan has since been removed. The page now directs to the health plan’s medical policy.
“We are pleased that Blue Cross Blue Shield of Mississippi has taken steps to comply with federal preventive coverage requirements by adding these two PrEP drugs,” Schmid said in a statement Monday. “The people of Mississippi deserve the same benefits of innovative HIV prevention tools that other people across the country have access to.”
Despite federal requirements, gaps in PrEP coverage remain
Mississippi has one of the highest rates of new HIV diagnoses and the highest HIV death rate in the country, according to Centers for Disease Control and Prevention data. It has the lowest rate of people who take PrEP compared to rates of new diagnosis. Medical providers and advocates say this shows that Mississippi is not doing enough to counter the preventable virus.
The virus disproportionately affects Black and Hispanic people in Mississippi. Black Mississippians are diagnosed with HIV at a rate five times that of white residents.
Chaney, the state official tasked with regulating insurers, told Mississippi Today in a June 8 phone call it is not his responsibility to regulate the prescription drugs a private health plan covers.
“It’s up to them to do that, and that’s an option for them,” he said in a follow-up conversation Monday. “It’s the same thing I told Blue Cross. ‘I’m not forcing you to do anything, but you’ve got to do the right thing.’”
Under the Affordable Care Act, a landmark healthcare reform law enacted in 2010, most private insurers are required to cover preventive healthcare services that receive an “A” or “B” recommendation by the U.S. Preventive Services Task Force at no cost to patients.
In 2019, the task force gave an “A” rating for prescribing PrEP to people at high risk of contracting HIV. At the time, the only Food and Drug Administration approved form of PrEP was Truvada, a daily oral pill. A generic version of the medication was introduced in 2020.
In 2023, U.S. Preventive Services Task Force expanded its recommendation to include Descovy, which is preferred for people with pre-existing kidney conditions, and Apretude. The Centers for Medicare and Medicaid Services clarified in 2024 that plans must cover all of these medications.
Self-insured plans, which are common among large employers, and plans existing before the Affordable Care Act went into effect, are exempt from the ACA requirements for preventive healthcare services. Under federal law, states exercise primary enforcement authority over health insurance insurers in the group and individual markets to ensure compliance with Affordable Care Act reforms. The federal government can step in and enforce requirements if states do not.
Research shows gaps in PrEP coverage persist despite the federal preventive care regulations. A recent study by the AIDS Institute found that most health insurance plans available through the Affordable Care Act Marketplace do not clearly communicate that PrEP is covered without cost-sharing, and a quarter do not include PrEP on their preventive service lists.
Rashad Pollard is a PrEP coordinator for Open Arms Healthcare, a Jackson clinic that prescribes PrEP to roughly 250 patients in Mississippi. He said he has faced difficulty helping patients obtain coverage for some PrEP medications through Blue Cross.
He said because there was previously no prior authorization process for the medication, he has had patients whose providers were forced to write letters to Blue Cross asking the insurer to cover Descovy. Responses typically take at least two months, and as a result, patients may go without prevention coverage during that period, he said.
Pollard said similar gaps exist in some other health plans, too, but he has noticed insurers increasingly expanding PrEP coverage options.
“We are seeing medications being added to formularies,” he said. “We know that there are some changes taking place.”
June Gipson, CEO of My Brother’s Keeper, the Ridgeland-based health and advocacy nonprofit program that runs Open Arms, said the organization has found creative ways to overcome barriers that limit access to PrEP. These efforts include providing insurance coverage to PrEP patients and leveraging a federal program that lowers medication costs.
Gipson said she believes it is short-sighted to limit access to a range of preventive medications for a serious disease, particularly given how effective they have proven to be. She added that certain types of medications may be more effective for different people based on existing health conditions or circumstances.
“Why would you limit people in Mississippi to just one method?” she asked.
Advocates denounce insurance commissioner’s comments on PrEP and HIV prevention
Chaney told Mississippi Today he does not believe health insurance companies should be forced to cover costly HIV prevention medications in order for people to “have a lifestyle they want to have.”
“What the HIV people are asking us to do, or what the insurance companies tell me, is to provide these — these drugs are very expensive, by the way, $28,000 a year — to people who want them, just because they want to continue doing something they shouldn’t be doing,” Chaney said. “You know, publicly, somebody doesn’t want to say that. I don’t mind saying it. You know, my goodness, accept some personal responsibility. Know what the risks are.”
Chaney did not specify the lifestyle or medication he was referring to, but Yeztugo, a twice-yearly injectable PrEP medication approved by the FDA in 2025, has a list price of about $14,000 per shot, according to Gilead, the drug’s manufacturer.
Mississippi Medicaid covers generic Truvada, Descovy, Apretude and Yetzugo with no copay for patients, according to spokesperson Matt Westerfield.
Federal regulations have not clarified that health plans must cover Yeztugo, although many insurers do. According to Gilead, 95% of people in the U.S. had insurance coverage for the medication as of its May 2026 shareholder report.
However, the HIV and Hepatitis Policy Institute argued in its June 1 letter to Chaney that federal preventive care coverage requirements should apply to all FDA-approved PrEP medications, including Yeztugo.
Research has shown that long-acting injectable forms of PrEP are more effective at preventing transmission of HIV than daily oral pills because they improve adherence to the medication.
Chaney made similar comments to the Magnolia Tribune, saying that he does not support people accessing medication at no cost “so they can do promiscuous things.”
In a statement, Schmid said the commissioner’s comments are discriminatory.
“It is due to attitudes like this that Mississippi has the third-highest HIV diagnosis rate in the country,” Schmid wrote. “The Supreme Court has affirmed preventive coverage requirements, and it is the insurance commissioner’s job to enforce the law, not to decide who deserves the protections to which they are entitled.”
Elizabeth Kaplan, director of healthcare access for the Harvard Law School’s Center for Health Law and Policy Innovation, said there is no scientific or ethical basis for Chaney’s statements. She added that they undermine HIV advocates’ decades-long work to destigmatize HIV.
“PrEP is appropriate for anyone who wants to take action to protect themselves from HIV,” she said, adding it is used as a prevention tool for a variety of people, including those in heterosexual relationships, committed relationships in which only one person has HIV, by women and people experiencing domestic violence.
Advocates say barriers to HIV treatment access persist
The HIV and Hepatitis Policy Institute also raised concerns about Blue Cross of Mississippi’s coverage of long-acting injectable HIV treatment medication in its letter to Chaney, an issue advocates have raised in the past.
Blue Cross Blue Shield considers Cabenuva, the only standalone long-acting injectable HIV treatment regimen, “not medically necessary,” according to online policy documents.
Lindsey Dawson, associate director for HIV Policy at KFF, said this policy could suggest that Blue Cross is an outlier in its coverage options for treatment of HIV.
“I’m not aware personally of a plan unilaterally saying that a specific medication is not medically necessary, particularly when there’s other federal guidance that provides clear guidance around why and when those drugs are effective,” she said.
Mangrum said Blue Cross’ prescription drug formulary includes approximately 20 treatment options for HIV.
“If clinical circumstances of a Member are not met with the treatment options on the formulary, an exception process is in place to work with the Network Provider to address the clinical needs of the Member,” she said in a written statement.
Mississippi lawmakers have tried unsuccessfully to prohibit such language. In 2024, a bill by Rep. John Hines, a Democrat from Greenville, would have barred health insurers from denying access to HIV treatment and medications on the grounds they were “not medically necessary.” It died in the House.
Kaplan said long-acting injectables are critical to ensuring that patients have access to effective care.
“There’s a very strong case that for a lot of people living with HIV, access to long-acting injectables is medically necessary and people should have access to them,” she said.
Fran Hutchins, executive director of the Equality Federation Institute, wrote to Blue Cross and Blue Shield of Mississippi in August 2025 to advocate for the insurer to cover Cabenuva or Biktarvy, a prescription medication used to treat HIV in adults and children.
In an October letter obtained by Mississippi Today, Blue Cross Chief Medical Officer Dr. Lee Greer responded that the plan covers other safe and cost-effective treatment options.
“HIV treatment currently available through Blue Cross & Blue Shield of Mississippi meets the treatment needs of its Members,” Greer wrote.
Hutchins told Mississippi Today that HIV treatment plays a key role in prevention because the medications can lower a patient’s viral load to undetectable levels, effectively preventing transmission of the virus.
Pollard, the PrEP coordinator, said he takes PrEP himself. He said he takes Descovy due to existing health conditions and medication interactions.
When he started in his current role in 2025, which provides Blue Cross health insurance, he found that his prescription for Descovy was not covered.
“I had to be a PrEP coordinator for myself,” he said.
To afford the medication, he relied on a pharmaceutical company’s drug assistance program that provided free medication for up to a year, but he has grown worried about his coverage options as his renewal approaches. He does not expect to qualify again because of his insurance coverage.
Pollard reviewed Blue Cross’ formulary Tuesday and discovered Descovy is now included on the plan’s drug formulary.
“As soon as we get off the phone, I’m going to talk to my provider,” he said.
This article was originally published by Mississippi Today and is republished here under a Creative Commons license.
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