This Man was Denied Coverage for PrEP and It’s Unacceptable

By Maryam

In a recent case that has gained a lot of exposure, a gay man was denied coverage for PrEP in a pre authorization denial letter from UnitedHealthcare. After James Krellenstein from ACT UP NYC, posted the letter on Facebook (patient is anonymous), HIV activists set off the alarm and accusations have run rampant towards UHC for blatant discrimination and institutionalized homophobic practices.

The letter stated that  “High-risk homosexual behavior” is not under the health plan criteria for covering PrEP. Instead, it specifically states that it is covered “to reduce the risk of sexually acquired HIV-1 infection in adults at high risk”. At first glance, this is clear discrimination against the same gender loving people and evidence of a careless, non-personalized rejection just to deny coverage. But what it also highlights is one of the many absurd barriers people face when trying to access PrEP.

Not only do individuals seeking protection from HIV need to overcome fear, stigma, and concerns over cost, but also the huge feat of navigating the extremely complex insurance system. This request was denied most likely because of an administrative error in an automated pre-authorization request. But why does Truvada for PrEP need pre-authorization anyways? According to Krellenstein, “ The only reason to disincentivize people from taking Truvada is for the insurance company’s profit margin”. In response, he created a letter to the NY State Commissioner to investigate this issue.

Attempting to navigate the healthcare system while dodging stigma and balancing payment assistance programs can be and often is incredibly frustrating. Here, we are trying to make it easier by eliminating the number of hurdles that stand between an individual taking ownership of their HIV status and an underutilized, life changing drug. With all the updates and changes within the healthcare world, it is imperative to have someone navigate and coach patients through the process of accessing PrEP. Everyone needs an advocate, and we are dedicated to ensuring a seamless experience to get started and stay on PrEP.

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