A man in New York was denied Truvada coverage by his health insurance plan because he is at risk of “engaging in high-risk homosexual behavior.”
The denial letter issued by United HealthCare was originally posted on Facebook by a group which advocates for HIV/AIDS awareness.
It reads in part, “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.”
Ironically the letter further explains, among other things, that in order for the plan to cover Truvada it must be used for people who are HIV positive or the prevention of HIV exposure to “high risk” patients.
Apparently, United HealthCare felt the policy holder did not fall into the categories spelled out in their guidelines.
Tens-of-thousands of people take Truvada in the United States and has been proven effective against HIV infection 99-percent of the time. A prescription can cost $1,500 per month without insurance.
“This was a malicious attempt to discourage PrEP (pre-exposure prophylaxis) uptake by people who need it most,” Jeremiah Johnson of the Treatment Action Group tells Raw Story.
The New York man was finally able to convince his insurance company to pay for the drug thanks to his doctor.
But this interaction between patient and insurance companies is an example of the difficulties in the system when people try to get the medicine.
Johnson also says prescriptions are ordered online and sent through the mail and that is a privacy concern.
Doctors must also file a medical report four times a year on patients taking the drug.
“This is an enormous barrier for some people,” he says
United HealthCare has yet to make a comment about their actions.