What if your insurance denied you coverage because you responsibly took a drug to prevent you from getting HIV? Unfortunately, this is an all-too common practice, but a legal victory today could make it a thing of the past.
A settlement was reached today in the Massachusetts lawsuit Doe v. Mutual of Omaha which challenged an insurance company’s policy on denying applicants’ various forms of coverage for taking Truvada, a medication taken for HIV prevention.
The lawsuit, which GLAD (GLBTQ Advocates and Defenders) filed against Mutual of Omaha, has resulted in the insurance company revising their underwriting guidelines that previously dictated that applicants who take Truvada, a pre-exposure prophylaxis for HIV commonly known as PrEP, were automatically declined for long-term care insurance. Long-term care insurance generally covers things like home care, assisted living, adult daycare, respite care, hospice care, or nursing homes; types of care that aren’t always covered by health insurance or Medicare.
As a result of the outcome of the suit, the plaintiff in the case, known only as John Doe, will receive the long-term care policy he applied for.
“We are pleased that Mutual no longer declines insurance coverage based on the use of HIV pre-exposure prophylaxis, and we call upon other providers of life, disability, and long-term care insurance to do the same,” said Bennett Klein, AIDS Law Project Director for GLAD, in a press release Tuesday. Klein also represented Doe in the lawsuit.
Mutual of Omaha told INTO on Tuesday that it is revising their underwriting guidelines and that they were no longer “[declining] long-term care insurance applications solely on the basis that an applicant takes Truvada as PrEP for HIV prevention.”
Truvada, which was approved for use by the Food and Drug Administration (FDA) in 2012, reduces the risk of users contracting HIV by more than 90 percent, according to the Center for Disease Control and Prevention. The health protection agency openly sanctioned the use of PrEP for reducing risk of contracting HIV in 2014.
The CDC also reported that 90,000 PrEP prescriptions were filled in 2018, with a total of 1.1 million Americans at risk for HIV nationwide.
Generally, the Affordable Care Act bars discrimination against applicants on the basis of their sexual orientation for health insurance, but allows states to determine applicant eligibility for other types of insurance, such as life insurance or disability insurance.
Unfortunately, Mutual is hardly the first insurance company to reject applicants for taking PrEP. In February 2018, the New York Times reported on a similar circumstance in which Dr. Philip J. Cheng, an openly gay Massachusetts doctor, was only offered coverage for five years on a disability insurance plan because of his PrEP use.
The article also highlighted how insurance applicants who take PrEP are indirectly penalized for taking a preventative medication by insurance companies, while those who do not are much more likely to receive coverage.
“I was really shocked,” Dr. Cheng told NYT at the time. “PrEP is the responsible thing to do. It’s the closest thing we have to an HIV vaccine.”
Following the NYT report, New York state financial regulators stated publicly that they would investigate reports of gay men who had been denied various forms of insurance, including disability and long-term care, because of taking PrEP.
“Denying insurance to people who take steps to prevent HIV makes no sense, undermines public health, and contributes to HIV stigma,” said Gabriel Arkles, senior staff attorney at the ACLU, in an email to INTO Tuesday. “We are pleased that Mutual of Omaha will no longer discriminate against people who take advantage of this form of preventive medicine.”