United HealthCare Denies PrEP to Gay Man for 'High Risk Homosexual Behavior'

An insurance company is making headlines this week for denying a gay patient access to Pre-Exposure Prophylaxis because of what they decree to be his "high-risk homosexual behavior," despite that the medication has been specifically targeted to that demographic.

An article in the Los Angeles Blade reports that United HealthCare has decided to ignore the Centers for Disease Control, the FDA, scientists and healthcare advocates and deny a gay man coverage for his doctor-prescribed Truvada, an oral medication by Gilead Science.

For years, federal and state governments have been advocating the use of PrEP to stop transmission of HIV/AIDS. "Pre-exposure prophylaxis (or PrEP) is when people at very high risk for HIV take HIV medicines daily to lower their chances of getting infected. PrEP can stop HIV from taking hold and spreading throughout your body. It is highly effective for preventing HIV if used as prescribed, but it is much less effective when not taken consistently," says the CDC.

But despite the fact that United HealthCare does not include sexual orientation or gender identity in their non-discrimination policy, they chose to deny one man's request for PrEP.

"The request for coverage for Truvada is denied. This decision is based on health plan criteria for Truvada. The information sent in shows you are using this medicine for engaging in high-risk homosexual behavior," reads the letter on United HealthCare letterhead posted on a Facebook site frequented by people impacted by HIV/AIDS. "This determination is considered to be a determination that the requested coverage is not medically necessary under New York State Law for the purposes of your appeal rights."

But the assertion that the denial is valid under New York state law is not true, according to HIV activist Jeremiah Johnson. "This was a malicious attempt to discourage PrEP (pre-exposure prophylaxis) uptake by people who need it most," Johnson, of the Treatment Action Group, told Raw Story. �

Johnson also noted that the man's doctor appealed and the drug was eventually covered. But the intricate doctor's reports, ordering Truvada online and having it delivered through the mail "is an enormous barrier for some people," he said.

ACT Up NYC member James Krellenstein has already alerted the community via Facebook, asking people to sign a letter asking New York State's Health Commissioner "to investigate and stop this bigoted conduct."

Krellnstein told LGBTQ Nation that, "This is a direct attack on the rights of our community to have access to healthcare. It is preventing people from protecting themselves from HIV infection. This is unacceptable. You can't discriminate against gay patients. You can't endanger patients' welfare because of your homophobia."

There has been no response, as of yet, from either United Healthcare or Gilead in regards to this case, or about their pre-authorization process or criteria.