Landmark Supreme Court Decision Protects Free Access to PrEP, Preventive Healthcare
The Court’s ruling upholds a key provision of the Affordable Care Act and represents an important victory for HIV prevention and health equity
In a 6-3 decision released June 27, the U.S. Supreme Court upheld a key provision of the Affordable Care Act (ACA) that requires insurers to cover preventive services like HIV prevention medicine, cancer screenings, and vaccines at no cost.
The ACA requires most insurers to cover at no cost all preventive services that receive “A” or “B” ratings from the U.S. Preventive Services Task Force (USPSTF). This includes HIV pre-exposure prophylaxis, or PrEP, as well as screenings for diseases and conditions such as cancer and depression, and a range of vaccines.
The plaintiffs in Kennedy v. Braidwood argued members of the USPSTF were appointed improperly and required Senate confirmation. In its ruling, the Supreme Court reversed an earlier decision from the Fifth Circuit and left the USPSTF and ACA preventive care mandate intact.
The Court’s decision does not mention PrEP explicitly, but PrEP was the impetus for the litigation in the first place. The plaintiffs, a group of Christian business owners, argued that being required to cover PrEP “encourages homosexual behavior” and therefore goes against their religious principles. PrEP is used by people of all sexual orientations and it is the recommendation of the Centers for Disease Control and Prevention that 1.2 million Americans could benefit from PrEP access.
New data from AIDSVu show that PrEP use has increased in the U.S. but remains relatively low. In 2024, 591,475 people were accessing PrEP, slightly under half the number recommended by the CDC. Low uptake can be explained in part by disparities in access. For example, while Black people account for nearly 40% of all new HIV diagnoses in the U.S., only 15% of PrEP users are Black. And while women account for 19% of new HIV diagnoses, only 9% of PrEP users are women.
No-cost access to PrEP is critical to ensure the medication can reach everyone who needs it. The Supreme Court’s ruling in Kennedy v. Braidwood is a significant win for health equity. A newly FDA-approved long-acting PrEP, lenacapavir, stands to revolutionize HIV prevention, but it “will only be as effective as it is accessible and affordable,” amfAR CEO Kevin Robert Frost said.
While today’s decision is a win for PrEP access, PrEP is just one component of a comprehensive U.S. HIV prevention strategy, much of which remains in jeopardy. The Court’s ruling will not prevent the federal government from gutting critical prevention programs at the CDC, community-based healthcare delivery programs, and Medicaid, upon which millions of Americans, including those living with and at risk for HIV, rely for all of their healthcare needs.
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