Insurer UnitedHealthCare (UHC), on Aug. 3, seemingly dropped controversial pre-authorization requirements it had recently introduced for physicians prescribing the oral medication Truvada for pre-exposure prophylaxis, or PrEP.
Minnetonka, Minnesota-based UHC, on July 1, began requiring physicians to obtain quarterly authorizations for PrEP claims; those authorizations had previously only been required annually. UHC also had required patients use its in-house mail-order pharmacy to obtain the medication, a rule that many patients reported difficulty in opting out of. The questionnaire physicians were required to submit was, according to some advocates and healthcare-providers, invasive of patients' privacy, asking whether Truvada was being prescribed for "high-risk" homosexual, bisexual or heterosexual behaviors.
The situation came to a head Aug. 3 when New York-based activist James Krellenstein posted to Twitter a mid-July letter from UHC denying PrEP to an acquaintance. The letter said the denial was issued because the patient intended to use the medication for "high-risk homosexual behavior."
In a statement, UHC National Communications Director Lynne High said, "We apologize for the insensitive language appearing in the letter and regret any difficulty it caused. We have corrected our letters, removed the prior authorization requirement for Truvada and members can fill their prescription at the network pharmacy of their choice. This is effective immediately."
The Refiner29 website originally reported the statement on Aug. 3.
Chicago physician Andrew Pavlatos said he was so incensed by the initial questionnaire that he returned it with a note that the question was illegal.
"It asks if you are gay, straight or bisexual," Pavlatos said. "Who the hell cares? If you're at risk, you're at risk—your doctor determines that."
The National Coalition for HIV Health, as well as a number of HIV/AIDS advocacies, on Aug. 4, nevertheless sent a letter requesting a meeting with UHC officials over the matter. AIDS Foundation of Chicago (AFC) was among the signatories on the letter, which noted that the rules may violate the Affordable Care Act's non-discrimination protections.
"PrEP is a critical advancement in HIV prevention that, when taken as prescribed, can provide nearly 100% protection from acquiring HIV infection," said the letter. "Stigma and discrimination are major barriers that have impeded uptake of this highly effective prevention intervention. In addition to violating multiple laws, the new policies have been implemented in such a way as to insult and disrespect UHC members."
The PrEP intervention has been shown to prevent the risk of HIV transmission by as much as over 90 percent. But advocates and service providers have struggled with wider implementation of PrEP due to a number of factors, among them educating diverse audiences and the high cost of Truvada, which can run more than $1,800 a bottle.
Windy City Times asked the Illinois Department of Insurance to comment on the legality of the rules with regards to the state's human rights laws, but did not receive a response by publication time.
Refinery 29's article is at www.refinery29.com/2017/08/166525/insurance-discrimination-hiv-prevention-truvada-prep-gay-man.
