Advertisement
The Body: The Complete HIV/AIDS Resource Follow Us Follow Us on Facebook Follow Us on Twitter Download Our App 
Professionals >> Visit The Body PROThe Body en Espanol

Blog

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.

Advertisement

"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.

Send Mark an email.

Get email notifications every time this blog is updated.


Related Stories

After Uproar, UnitedHealthcare Reverses Truvada Prescription Policy
Fact Sheet: HIV/AIDS and Young Men Who Have Sex With Men
Quiz: Are You at Risk for HIV?
10 Common Fears About HIV Transmission
More on HIV Prevention Issues for Gay Men


This article was provided by MyFabulousDisease.com. Visit Mark's live blog.
 

No comments have been made.
 

Add Your Comment:
(Please note: Your name and comment will be public, and may even show up in
Internet search results. Be careful when providing personal information! Before
adding your comment, please read TheBody.com's Comment Policy.)

Your Name:


Your Location:

(ex: San Francisco, CA)

Your Comment:

Characters remaining:

BLOG:
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.

Speaking engagements: Mark King is available to speak to groups. Contact Mark about speaking at your organization or event!


More About Mark:
Profile


Subscribe to Mark's Blog:

Subscribe by RSSBy RSS ?

Subscribe by Email


Recent Posts:

View All Posts


A Place Like This by Mark King

View an excerpt of Mark's book

To read PDF, click here


Interviews With Mark:

Mark King Looks Back at the AIDS Epidemic's Darkest Hour in the U.S. (May 14, 2008)

This Month in HIV: Crystal Methamphetamine and HIV (August 2007)

For the rest of Mark's articles, click here.


A Brief Disclaimer:

The opinions expressed by TheBody.com's bloggers are entirely their own, and do not necessarily reflect the views of TheBody.com itself.

Advertisement

The content on this page is free of advertiser influence and was produced by our editorial team. See our advertising policy.