August 5, 2017

In NY Insurance Has Denied HIV Med To a Gay Man Because His 'High Risk of Homosexual Behavior'

A patient applied for Truvada, FDA's only approved drug to prevent HIV infection, in July

The New York man received a denial letter citing his 'high risk homosexual behavior' as the reason
However, Truvada criteria state the drug should be covered for adults 'at high risk of sexually acquiring HIV-1'

HIV activism groups claim this is hardly the first case of a baseless denial
They also slam the language of the letter and 'down right discrimination'

United Healthcare has overturned the decision amid uproar over the letter
Dr Anthony Fauci, head of HIV at the NIH, told Daily Mail Online 'it seems like an inherent contradiction: PrEP was approved to prevent HIV for people at risk' 

An insurance company refused to cover a gay man's HIV-prevention drug because he 'engages in High risk homosexual behavior'.

The man, who lives in New York, applied for Truvada's PrEP in July to protect himself from the life-threatening disease. The drug is the only FDA-approved antiretroviral treatment to block HIV from infecting cells. 

But days later he received a denial letter from United Healthcare, which stated: 'The information sent in shows you are using this medicine for High risk homosexual behavior'.

The company claimed health plans only cover Truvada for patients who have HIV or have been exposed to the virus, adding that his request for coverage 'is not medically necessary under New York State Law'.

However, the letter also includes a list of United Healthcare Truvada criteria, which state that the drug - which costs $1,450 a month wholesale - should be covered for adults 'at high risk of sexually acquiring HIV-1'.

HIV activism groups have slammed the denial as illegal, and the phrasing of the letter as 'homophobic and discriminatory'.

Dr Anthony Fauci, director of the HIV/AIDS department at the National Institutes of Health, told Daily Mail Online: 'It seems like an inherent contradiction.

'PrEP is made for people who are actually at risk for HIV infection, not for people who are not at risk. 
'It has been proven that PrEP is a highly effective way of preventing HIV infection. That is the reason Truvada was approved.'

After receiving the letter on July 11, the patient, who remains anonymous, went to HIV activism groups for support to appeal the decision.

He sent the document to Jeremiah Johnson, of Treatment Action Group (TAG), who has led calls against the insurance company and the state health department to acknowledge the denial as a violation of guidelines.

'At best, it's gross incompetence of the insurer to carry out their own policy,' Johnson told Daily Mail Online. 'At worst, it's down right discrimination and it's illegal. 
'The patient was shocked by the language, as we all are.

'The words they use were stigmatizing terms on their own, but when you send that on UHC letterhead, saying "you're being denied this essential medication because you're homosexual"... We were just horrified.

'It's a clear violation of policy, it's unethical and it's malicious to deny people who are vulnerable.' 
The patient appealed to overturn the decision through his doctor, and has now been issued PrEP.
However, activism collectives have launched a petition to New York State Health Department to condemn United Healthcare's denial letter.

James Krellenstein, of ACT UP NYC which is behind the letter and petition, said this is hardly the first case of a baseless denial.

'We are hearing story after story of patients being denied Truvada coverage despite being fully in compliance with CDC, federal and state guidelines,' he told Daily Mail Online. 
'Often you can appeal the decision and get approved, but studies show these kinds of denials deter people and led to lower overall coverage.

'The language in this letter shows that this case is a black and white case of discrimination based on the patient's sexual orientation.'
Krellenstein pointed out that last year the New York City Health Department issued guidelines to doctors, highlighting gay men as candidates for PrEP.

And federal guidelines from the National Institutes of Health say the LGBT community is one of the most vulnerable populations to HIV infection, and therefore should receive PrEP. 
'United Healthcare endangered a patient's health because of his sexual orientation,' Krellenstein said.
'Every time this happens, insurance companies are endangering the health and well-being of the entire LGBT community.'

United Healthcare has not responded to Daily Mail Online's request for a comment.
The CDC last year said that 1.5 million Americans could benefit from taking PrEP to lower their risk of contracting HIV sexually or through intravenous drug use.

Contradiction: The letter included Truvada's criteria, which states that the drug is meant for adults at high risk of sexually acquiring HIV. It is the only FDA-approved drug for that purpose
Currently, figures suggest just over 100,000 people take the drug.
Krellenstein urged insurance companies to make contact with HIV activism groups to discuss coverage, criteria, and costs.

'We are interested in solving this problem, we're willing to sit down with UHC or any insurance company to work this out,' he said.

'But we are not going to remain silent while they endanger the health and well-being of our community.'

Johnson urges people who have been denied PrEP to visit the National Coalition for LGBT Health, which allows patients to anonymously share their stories and get support to appeal the decision if necessary.

'Don't shame yourself if you were denied,' Johnson adds.

'This is a stigmatized medication, like the contraception pill was years ago. Anyone taking a stigmatized medication needs to be very persistent.

'Work with your doctor to keep appealing the decision, and do what you can to make HIV activists aware if you were denied.'

By Mia De Graaf For 

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