A major health insurer has been denying prescriptions for Truvada, a primary medication in the highly effective Pre-Exposure Prophylaxis (PrEP) HIV-prevention program which seeks to curb new infection rates, citing “high-risk homosexual behavior”, HIV/AIDS advocates say.

By Nathan James

United Healthcare, whose 115 million subscribers make it one of America’s largest healthcare carriers, has been routinely sending out denial-of-coverage letters to those seeking Truvada, which reads in part, “The request for coverage for Truvada is denied. The decision is based on health plan criteria for Truvada. The information shows that you are using this medicine for High [sic] risk homosexual behavior. The determination is considered to be a determination that the requested coverage is not medically necessary under New York State Law for purposes of your appeal rights.”

James Krellenstein

James Krellenstein, an advocate with the AIDS Coalition to Unleash Power (ACT UP), who saw the denial letter on a Facebook HIV-awareness group page, furiously decried United Healthcare’s decisions. “This is a direct attack on the rights of our community to have access to healthcare,” Krellenstein fumed. “It is preventing people from protecting themselves from HIV infection. This is unacceptable. You can’t discriminate against gay patients. You can’t endanger patients’ welfare because of your homophobia.

Dr. Thomas Frieden

PreP is a Centers for Disease Control (CDC)-sponsored program which has proven to be better than 90% effective in preventing infection of HIV-negative patients who have sex with HIV-positive partners.

A federal government study showed that if used as directed, Truvada, which is made by Gilead, can “promote significantly better outcomes and reduce the incidence of new HIV cases in the community,” said Dr. Thomas Frieden, CDC director and former New York City health commissioner. “the emphasis has been to teach CDC PreP protocols to doctors and hospitals, in order to help bring the epidemic under control“. PrEP was developed through funding by federal research grants.

Initiatives like PrEP are especially important in the Black gay community, where infection rates are reaching unprecedented levels. “One in two Black gay men can expect to become HIV-positive in their lifetime,” Frieden warned. An estimated 1.6 million people are currently living with HIV or AIDS in the US, the CDC says, and of that number, as many as a third of them don’t know they are HIV-positive.

Although big marketing campaigns announcing the availability of PrEP have been launched in major cities, accessibility is still an issue, with cost being a serious obstacle. “I know people for had to stop using Truvada because they couldn’t afford it. The can’t afford the out of pocket costs, the co-pays or the deductibles, which can be really high,” Krellenstein says. “Gilead has a patient assistance program that covers up to $3,600 dollars in costs, but lower quality health plans can have medication deductibles as high as $6,000 or more.”

Jeremiah Johnson

In denying coverage for Truvada, United Healthcare is apparently contradicting its own criteria for the meds, advocates say. Their authorization guidelines state that treatments are permitted “to reduce the risk of sexually acquired HIV-1 infection in adults at high risk”, but the company’s denial letters are explicitly discriminatory, said Jeremiah Johnson of the Treatment Action Group. “This was a malicious attempt to discourage PrEP (pre-exposure prophylaxis) uptake by people who need it most,” Johnson observed.

United Healthcare officials declined comment for this story.