Our research helped preserve no-cost PrEP access

Affordability of PrEP has been a significant challenge, with out-of-pocket costs for just one month of PrEP running into the thousands of dollars. In 2020 the U.S. Preventive Services Task Force (USPSTF) awarded oral PrEP an “A” rating, requiring most insurers to cover PrEP and its associated medical services at no cost sharing beginning in 2021.

However, this major improvement in access was soon threatened by Braidwood Management v. Becerra (later Kennedy v. Braidwood Management), in which plaintiffs argued the USPSTF’s authority and the PrEP coverage mandate violated their religious rights. In 2022, a Texas district court struck down the mandate, though the ruling was later appealed and ultimately reached the U.S. Supreme Court in 2025. This case had sweeping implications, not only for the 1.2 million needing PrEP access but also for the 150 million people benefiting from the no-cost preventive services mandate under the Affordable Care Act (ACA).

Our Research

In 2024, Lorraine Dean, ScD, and Jalpa Doshi, PhD, published a Health Affairs paper analyzing how out-of-pocket costs affect PrEP uptake. They found that nearly 1 in 5 patients abandon their first insurer-approved PrEP prescription at the pharmacy, with most never returning to fill it later in the year. Those who forgo PrEP face a threefold higher risk of contracting HIV within one year.

Their cost-simulation analysis underscored just how sensitive PrEP initiation is to patient cost sharing: at $0 out-of-pocket cost, only 6% of patients abandon PrEP; at just $10, the abandonment risk more than doubles; and at costs above $500, 43% abandon PrEP. This was the first national, population-level evidence quantifying how even modest out-of-pocket costs limit PrEP use and increase HIV risk.

Role in Supreme Court Case

Their research was cited as key evidence in nine amici curiae briefs submitted to the Court. These briefs used the researchers’ findings to illustrate the real-world negative consequences of striking down no-cost PrEP coverage and to caution the Court about unintended public health ramifications of a decision that threatened the ACA’s no-cost preventive services mandate. These briefs came from leading health organizations, researchers, and advocates, including the National Alliance of State and Territorial AIDS Directors, Gilead Sciences, the Chronic Illness and Disability Partnership, the HIV and Hepatitis Policy Institute, patient and physician professional organizations, 48 bipartisan economic and social science scholars, the Center for HIV Law and Policy, the American Cancer Society, and 35 health care access organizations.

In June 2025, the Supreme Court upheld the USPSTF’s authority and preserved no-cost PrEP coverage—a major victory for HIV prevention and preventive health more broadly. Media outlets highlighted the researchers’ findings in their coverage of the Supreme Court decision, noting that even small increases in out-of-pocket costs can significantly undermine PrEP uptake and increase HIV risk.