Insurance Companies Are Denying Coverage to People on PrEP

Life, disability, and long-term-care insurance providers* have been denying policies to people on pre-exposure prophylaxis, according to a New York Times report. 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 136,000 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 added.

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 years.

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.