ACA Lawsuit Endangers HIV PrEP Coverage

A U.S. district court will hear arguments Tuesday in a case challenging the Affordable Care Act’s requirement that HIV preventative drugs must be fully covered by insurance.

Driving the news: Jonathan Mitchell, a former Texas solicitor general who helped draft part of the state’s six-week abortion ban, argues that mandatory HIV pre-exposure prophylaxis, known as HIV PrEP, violates the Religious Freedom Restoration Act, a law that “ensures that religious freedom interests are protected.” »

  • Mitchell’s clients include two businesses and several Texas residents who oppose the warrant on religious grounds, Bloomberg reports.
  • The law is often used in court cases challenging access to abortion and contraception, as well as health care for transgender people, according to Bloomberg.
  • Anti-HIV PrEP is more than 90% effective in preventing HIV transmission.

State of play: Mitchell argued in a November court filing that the plaintiffs in the case – Kelley Orthodontics, Joel Starnes, Braidwood Management Inc. and John Kelley – “do not wish to subsidize or provide insurance that encourages and facilitates the behavior gay sex, drug use, or extramarital sexual activity between a man and a woman.”

  • This “unquestionably qualifies as a ‘substantial burden’ on the exercise of their religion”.

The context: Under the ACA, most health insurance plans must cover certain recommended preventive services, including HIV testing for people ages 15 to 65 and HIV PrEP for adults at high risk of HIV infection. HIV.

  • In 20212, the FDA made Gilead’s Truvada the first drug approved for HIV prevention in uninfected adults.
  • In 2019, the US Task Force on Preventive Services recommended PrEP as an effective method of HIV prevention, meaning health plans had to make it available to patients free of charge as part of the ACA in January. 2021.

What we are looking at: If Mitchell and his clients win the case, HIV PrEP — which can cost up to $20,000 a year and is prescribed to tens of thousands of people — would become harder for patients to access.

Editor’s note: This title and article have been corrected to note that Jonathan Mitchell is the former state Solicitor General, not the current one. The lawsuit is being brought by private citizens, not the state of Texas.


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