Insurance Companies Are Denying Coverage to People on PrEP

Photo via AP

Life, disability, and long-term-care insurance providers* have
been denying policies to people on pre-exposure prophylaxis,
according to a New York Times
. PrEP, as the antiretroviral regimen is known, is
highly effective in preventing HIV negative people from
contracting the disease. There is some discussion as to what
percentage point it is technically effective, but for some
perspective: As of August 2017, an estimated
people were taking PrEP in the U.S. There have been
three known HIV transmissions of people in the world
in people adhering to PrEP as directed.

If denying people who are specifically protecting themselves
coverage doesn’t make any sense to you, well join the club. Per
the Times:

The denials turn the insurance industry’s risk-management
standard on its head: men who do not protect themselves can
get policies, while men who do cannot.

“It doesn’t make any sense,” said Dr. Anthony S. Fauci,
director of the National Institute of Allergy and Infectious
Diseases, and perhaps the nation’s best-known AIDS doctor.
“It ought to be the other way around.”

The Times points to expert testimonies suggesting this
is a growing trend, though, adding, “when companies did offer
explanations, they said applicants were turned down because the
company believed they must be engaging in high-risk sexual
behavior.” What constitutes “high-risk sexual behavior” is an
open question, especially in the population of men who have sex
with men, as the vast majority of PrEP adherents are (I’ve
heard doctors recommend PrEP to anyone who has more than two
unique sexual partners a month). This is a population so
scrutinized that even one of the subjects of this
Times piece, Dr. Philip J. Cheng, whose application
for disability insurance was turned down, felt the need to
state in the paper of record, “I never engaged in sexually
irresponsible behavior.”

The Times piece makes a very good argument that points
to the potential discrimination at work here beyond the
self-evident logical fallacy of behavior that’s protected from
HIV being “high-risk.” (With HIV off the table, what is the
actual risk? An STI? Well, people on PrEP are able to manage
those exceptionally well since they’re tested every three
months, which means an infection that might go unnoticed and
asymptomatic, will not.) Mutual of Omaha admitted that it
denied a man long-term care insurance because he’s taking
Truvada—the Gilead drug that provides the only means of PrEP
for U.S. residents at the moment. Reports the Times:

The drug is indicated only for persons with H.I.V. or at high
risk of acquiring H.I.V., the company said. Therefore it
turned down everyone taking Truvada.

“The fact that the drug is less than 100 percent effective
adds yet another layer to the risk profile,” the company

According to internal underwriting guidelines obtained by
[the man’s lawyer, GLBTQ Legal Advocates and Defenders’
Bennett Klein], Mutual of Omaha sells long-term-care policies
to people with Addison’s disease, bipolar disorder,
depression, mild coronary artery disease, diabetes, epilepsy
and high blood pressure, as long as they are controlled by
medication for various periods, from six months up to three

It also insures former alcoholics who were alcohol-free and
in support groups, as well as people who had recovered from
heart valve surgery or cancers of the bladder, breast,
prostate and skin.

These policies seem to be ignorant of how manageable and
avoidable HIV can be with the proper medicine, and reading this
story, you have to wonder if this ignorance is plain willful.

*Note: Most health insurance companies do cover PrEP.

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