NY Investigates Insurance Denials for PrEP Use

After Dr. Philip J. Cheng nicked himself while preparing an HIV-positive patient for surgery three years ago, he followed standard hospital protocol and took a one-month course of Truvada — a two-drug regimen that can prevent the transmission of HIV.

Truvada, manufactured by Gilead, is the branded name of PrEP (pre-exposure prophylaxis), an HIV prevention method continuing to gain in popularity simply for its extreme effectiveness. According to the Centers for Disease Control and Prevention, “Daily PrEP reduces the risk of getting HIV from sex by more than 90 percent,” and more recent studies have shown even higher numbers, in the 99 percent effectiveness range.

So naturally, as an unattached gay man at the time, Cheng decided to remain on Truvada as an extra step in protecting his health.

Cheng, a urology resident at Harvard’s Brigham and Women’s Hospital, told the New York Times 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. He applied right away 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 reported “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.”

The Times first published Cheng’s story on Monday, which then triggered an investigation by New York state financial regulators (announced Wednesday). State superintendent of financial services, Maria T. Vullo, said that such denials would amount to illegal discrimination based on sexual orientation, and the companies doing so could be penalized.

Beyond the legalities, HIV advocates 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,” echoed Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, and one of the nation’s foremost HIV experts. “It ought to be the other way around.”

When many of the insurance companies were pressed for explanations, few were received — and the ones that did respond said that applicants were turned down because the company 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.”