On July 11, 2017, the insurance provider United Healthcare sent a letter to Thomas Ciganko denying him access to pre-exposure prophylaxis (PrEP) — a medication which is highly effective at preventing HIV — citing his “high risk homosexual behavior.”
Although the insurer subsequently apologized for their “insensitive language” and promised to prevent such verbiage from appearing in future correspondence, after pushback from HIV activists, the insurer has also revised its policies, making PrEP more accessible for its patients.
How United Healthcare has changed its PrEP policies
According to HIV blogger Mark S. King, United Healthcare issued two significant revisions to its PrEP policies.
First, United Healthcare will no longer require prior-authorization for PrEP. Prior-certification required physicians to submit forms explaining why they wanted patients to be on the medication in the first place. HIV activists and PrEP proponents saw this as a needless additional barrier.
Second, United Healthcare will no longer require patients to exclusively use the insurer’s mail-order pharmacy to get the medication, an additional hurdle that made little sense seeing as most patients can easily get PrEP in person at local pharmacies.
But problems with health insurance and access remain
Despite their policy changes, unresolved issues remain. In his original online petition, James Krellenstein, the HIV activist and ACT UP NYC member who helped publicize Ciganko’s rejection letter, said that he wanted the New York State Health Commissioner to investigate how many other patients have been denied PrEP by UnitedHealthcare and other insurers because of their sexual orientation or gender identity.
It’s likely that Ciganko was not the only one.
Also, Krellenstein points out that PrEP’s exorbitant cost still makes the medication largely inaccessible to countless people.
“Gilead did not fund the research that led to Truvada being approved for PrEP. Despite this, Gilead charges over $1,500 per month for Truvada, when it only costs $9 to make,” Krellenstein said. “If we truly want to make PrEP universally accessible, we must, at some point, deal with Gilead.”
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