After both an investigation and a lawsuit, insurer Mutual of Omaha will halt their practice of denying health coverage to people using pre-exposure prophylaxis (PrEP) to prevent HIV infection.
The change was brought about by an investigation by the Massachusetts Attorney General’s office as well as a lawsuit, Doe v. Mutual of Omaha Insurance Company, filed by GLBTQ Legal Advocates & Defenders (GLAD).
“Throughout the 35 years we’ve been fighting AIDS, we’ve learned that access to medicine and health care isn’t enough. Even when science unambiguously shows the way, we have needed legal advocacy to protect the health of our community,” said Kenneth H. Mayer, M.D., the Medical Research Director and Co-Chair of The Fenway Institute, in a release.
In the case, the plaintiff was denied a long-term care policy due to the insurer’s policy of denying coverage to people who use PrEP and are HIV negative. The case argued that this was discriminatory against LGBTQ people, given that roughly 80% of PrEP users are gay men.
It may seem contradictory, but people who take PrEP to prevent infection are facing denials in coverage over insurer’s fears that those taking the medication are engaging in so-called “high risk” behaviors.
“It doesn’t make any sense,” said the director of the National Institute of Allergy and Infectious Diseases, Dr. Anthony S. Fauci, to the New York Times. “It ought to be the other way around.”
Mutual of Omaha, had argued they are right to turn down coverage, as PrEP is only for those at a high risk of being infected by HIV. They have also argued that, given the drug is not 100% effective, the use of it is also inherently risky.
It is estimated that 13,600 people are using PrEP in the United States alone, with the medication shown to be 99% effective against the transmission of HIV.
The settlement, of course, doesn’t apply to coverage with any other insurers beyond Mutual of Omaha. This points to the need for government to step in and prevent this practice.
New York and California have already opened their own investigations into the practice. Currently, only five states have laws that prohibit discrimination based on sexual orientation and gender identity in the health insurance industry.
Editor’s Note: This article originally said the change in policy would only be available in Massachusetts. While the settlement is specific to Massachusetts, the insurer will be changing the policy nationwide.