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New York Investigates Insurance Denials for PrEP Use

Truvada

Financial regulators in the state of New York are investigating reports that gay men on PrEP (pre-exposure prophylaxis) — the daily dosage of a drug that some studies say is 99 percent effective at preventing those taking it from acquiring HIV — are being denied health insurance.

The investigation was sparked by a Tuesday interview in The New York Times with Dr. Philip J. Cheng. In it, Cheng, a gay urology resident at Harvard’s Brigham and Women’s Hospital, said he was “really shocked” when he was denied long-term disability insurance specifically because of his PrEP use, and only offered a five-year policy.

Despite the fact that Cheng has no health issues, has never had surgery or been hospitalized, and takes no other medication, he was still denied coverage. “And I never engaged in sexually irresponsible behavior,” he added. “PrEP is the responsible thing to do. It’s the closest thing we have to an HIV vaccine.”

Even after Cheng offered to sign a waiver voiding his policy should he become HIV-positive, he unfortunately was forced to stop taking Truvada, the only drug approved for use as PrEP. He applied to a different insurer — and was offered a lifetime disability policy.

One can only wonder how many men have been confronted with this unfair decision, as the Times notes, “There are nearly 800 life insurers in this country. … There are no national figures on how many of them have denied coverage to men because they take PrEP.”

Maria T. Vullo,  New York State superintendent of financial services, told the Times such denials would amount to illegal discrimination based on sexual orientation, and the companies doing so could be penalized.

Beyond the legalities, HIV activists say these denials not only endanger people’s lives by encouraging them to drop PrEP if they need life, disability, or long-term care insurance, but will also increase transmission rates of the virus overall — which really affects everyone. In addition, such discrimination adds to existing stigma around HIV and homosexuality.

The Times report worded the level of irony and hypocrisy best: “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,” Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases and one of the nation’s foremost HIV experts, told the Times. “It ought to be the other way around.”

When many of the insurance companies were pressed for explanations, few responded — and the ones that did said that applicants were turned down because insurers believed they must be engaging in high-risk sexual behavior.

Vullo says the core of the issue is civil rights. “This is tantamount to penalizing applicants based on sexual orientation,” she said. “Insurers cannot choose to deny coverage based on discriminatory reasons.”

At present, New York is the only state reported to be spearheading such an investigation. However, the issue of PrEP discrimination is widespread, Ben Klein, a senior attorney at GLBTQ Legal Advocates & Defenders, wrote in a recent commentary for The Advocate:

Some of the largest insurance companies in the nation are engaging in this categorical exclusion of PrEP users. GLAD has heard directly about cases of discrimination by State Farm, Aetna, Metropolitan Life, John Hancock, Protective Life, Lincoln Financial, and many more. We have sued Mutual of Omaha Insurance Co. for denying long-term care insurance to a qualified HIV-negative gay man because he uses PrEP. This is an industry-wide policy and practice. Gay men can either get insurance or they can forgo taking the best biomedical HIV prevention method in the history of an epidemic that has claimed so many lives.

And Cheng's story is not just local news. The story was syndicated nationally and was published as far south as Florida, in the Tampa Bay Times. Vullo, while not aware of similar work by other state regulators, predicted that California regulators “will be aligned with me on this issue.”

This article was first published in Plus magazine.

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