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Insurer Denies Truvada Due to 'High-Risk Homosexual Behavior'

August 3, 2017

insurance company response to pre-authorization request

Discrimination against LGBT people is often once-removed, shielded under double-speak and fraudulent intentions. So, it's refreshing, really, when a company comes right out and says in black and white that gay men aren't worthy of the same protections as everyone else.

In a pre-authorization denial letter to a gay patient seeking Truvada as PrEP, UnitedHealthcare, Inc., cited "high risk homosexual behavior" as their reason for denying his claim. Seriously. Because we all know PrEP is meant for people who are, you know, not at risk for HIV infection.

That's not all. The letter from UnitedHealthcare, Inc., refers to their criteria for authorization, among them "to reduce the risk of sexually acquired HIV-1 infection in adults at high risk." So, adults at high risk are okay. Homosexual behavior crosses the line. (Strange, considering this UnitedHealthcare Truvada criteria document from 2013 makes no mention of the sexuality of the patient.)

The patient denial letter makes the obscene disconnect pretty clear:

insurance company response to pre-authorization request

James Krellenstein, a member of ACT UP NYC (and one of my "HIV Advocates to Watch" in 2015) who once convinced the FDA to approve the Alere Rapid HIV Test, was absolutely livid when he posted a redacted version of the UnitedHealthcare letter on social media this week. He was no less incensed in our interview.

"This is a direct attack on the rights of our community to have access to healthcare," James said. "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."

You can help fight this decision. James has created a letter to the Commissioner of the New York State Department of Health. Read it. Then sign on to the petition supporting the letter.


"The commissioner can rule they are discriminating," said James, "if he finds they are discriminating they can pull them from the health insurance market. He has the authority to do anything. We want UnitedHealthcare to disclose to the commissioner how many people have been denied for similar reasons, and an assurance that this conduct will cease immediately."

The fact that Truvada for PrEP requires a pre-authorization process at all is ludicrous. "They could change this tomorrow," said James. "It is an extra hurdle to get the drug, including filling out forms that ask questions about sexual behavior that then go through another level of bureaucracy."

Don't even get James started about the cost of Truvada as PrEP, considering Gilead, the maker of the drug, did not fund the research that proved the drug to be effective as PrEP. "The research was paid for by the U.S. taxpayer," James explains. "And they continue to raise the cost of the drug, 10% this year alone. They charge $1500 a month for this drug and manufacture it for $9. Based on their research investment in Truvada, Gilead should be charging the price of a bottle of aspirin for it."

"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. 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."

There has been no response, as of yet, from either UnitedHealthcare or Gilead in regards to this case, or about their pre-authorization process or criteria. So now is the perfect time to sign the petition.

Stay tuned.

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My Fabulous Disease

Mark S. King has been an active AIDS activist, writer and community organization leader since the early 1980s in Los Angeles. He has been an outspoken advocate for prevention education and for issues important to those living with HIV.

Diagnosed in 1985, Mark has held positions with the Los Angeles Shanti Foundation, AID Atlanta and AIDS Survival Project, and is an award-winning writer. He continues his volunteer work as an AIDS educator and speaker for conferences and events.

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