Insurance Co. Stops Denying Coverage of Truvada for HIV Prevention
Tags: FDA, Public Health, HIV, Truvada, Patient Safety

On Jan. 8, in response to allegations of discrimination by the Massachusetts attorney general’s office, Mutual of Omaha insurance company agreed that it will no longer deny life, disability, accident or health insurance, including long-term care insurance, to an individual solely because the individual takes the prescription drug Truvada.

Eighty percent of Truvada users are gay men, according to the New York Times.

What is Truvada for HIV Prevention?

Also known as PrEP (pre-exposure prophylaxis), Truvada is intended to prevent HIV in those who are not already infected but who are at risk of infection. Used daily, the little blue pill has been shown to be 92 to 99 percent effective at preventing the virus from taking hold in the body. First approved in 2012, Truvada is considered a significant milestone in the fight against HIV, according to the Boston Globe.

Although the agreement is specific to Massachusetts, the company told the Boston Globe that their change in policy went into effect nationwide in July 2018. Mutual of Omaha also agreed to pay the state of Massachusetts $25,000.

Massachusetts Insurance Company Settles Discrimination Lawsuit

On the same day, Mutual of Omaha also announced the settlement of a LGBTQ Legal Advocates and Defenders (GLAD) lawsuit on behalf of a 61-year-old man, “John Doe,” who was allegedly denied long-term care insurance by Mutual of Omaha solely because he takes Truvada. Bennett Klein, GLAD’s AIDS law project director, represented the plaintiff in the 2014 lawsuit, the first of its kind.

The suit alleged that Mutual of Omaha was violating Massachusetts laws that prohibit discrimination on the basis of sexual orientation and disability. GLAD argued that the company’s policies had no rational basis.

On the one hand, Mutual of Omaha insures individuals who are at risk for HIV infection, Klein told the New York Times, because the insurer does not screen applicants for high-risk sexual behaviors. On the other hand, the insurer denies individuals who are taking a medication which is highly HIV-protective and who are thus at very low risk for infection.

Unfortunately, Mutual of Omaha is apparently not unique in its discriminatory policies.

In an opinion piece in The Advocate, an LGBT-oriented publication, Klein and co-author Alex Weinstein asserted that insurance discrimination against Truvada users is an industry-wide practice.

“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,” Klein and Weinstein wrote.

“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,” the authors continued.

In 2018, the state of New York declared such insurer behavior unlawful, while officials from the state of California promised to investigate these practices, Klein told the Globe.

Manufactured by California’s Gilead Sciences, Truvada is a combination of two drugs used to treat active HIV infection. Most health insurers and state Medicaid agencies cover the drug, which is a good thing because the list price is nearly $2,000 for a 30-day supply.

Truvada Side Effects?

When it comes to drug safety, government agencies offer conflicting information.

The Center for Disease Control states on its PrEP Basics webpage that “No serious side effects have been observed, and these side effects aren’t life threatening.”

The National Institutes of Health, on the other hand, warns users of potentially life-threatening side effects from Truvada, including liver problems and lactic acidosis (a build-up of lactic acid in the blood).

Read more about the potential side effects of Truvada on MedTruth.

Featured photo by rawpixel on Unsplash

Carah Wertheimer

Carah Wertheimer is a freelance writer based in Boulder, Colorado. Her areas of specialization include food, health, environment, social justice and community reporting. Her work has appeared in the Denver Post, The Daily Beast, the Boulder Daily Camera, Boulder Weekly and other publications.