Medical groups 'deeply disturbed' by judge's ruling that endangers PrEP coverage under ACA
Key takeaways
- A federal judge ruled that the Affordable Care Act requirement mandating insurers to provide plans covering HIV-prevention drugs at no cost is unconstitutional.
- The ruling is another example of “unacceptable interference in science,” said Marwan Haddad, MD, MPH, chair of the HIV Medicine Association.
Medical organizations are expressing concern after a U.S. District Court judge struck down an Affordable Care Act requirement that requires employers to provide plans covering HIV-prevention drugs at no cost.
Marwan Haddad, MD, MPH, chair of the HIV Medicine Association, said in a statement that the organization “is deeply disturbed” by the ruling, which will allow employers in Texas to deny coverage for pre-exposure prophylaxis, or PrEP, “a highly effective biomedical intervention for preventing HIV infection.”
“This ruling is yet one more instance of unacceptable interference in scientific, evidence-based health care practices that must remain within the sanctity of the provider-patient relationship. Denying access to PrEP threatens the health of the more than 1.2 million Americans who could benefit from this potentially lifesaving intervention,” Haddad said in the statement. “Religious refusal laws allowing the personal beliefs of employers or health care providers to dictate access to prevention, care and treatment services are discriminatory and dangerous. These laws ultimately hurt everyone.”
The ACA mandated that employers and insurers cover “evidence-based items or services that have in effect a rating of ‘A’ or ‘B’ in the current recommendations of the United States Preventive Services Task Force” without cost-sharing requirements. The USPSTF gave PrEP an A rating in 2019.
Steven F. Hotze, MD, the president of Braidwood Management Inc., an employer in Texas and a plaintiff in the case, argued that “these drugs facilitate behaviors such as homosexual sodomy, prostitution and intravenous drug use, all of which are contrary to Dr. Hotze’s sincere religious beliefs.”
Hotze, also CEO of Hotze Medical Association, also took issue with preventive care mandates like covering STD screenings for people “engaged in non-marital sexual behavior.”
Judge Reed O’Conner wrote that the defendants, who argued that reducing the spread of HIV is a “compelling government interest,” did not prove that the PrEP requirement furthers that interest. He also said the government did not prove that PrEP “is the least restrictive means of furthering” that interest, adding that “the PrEP mandate substantially burdens the religious exercise of Braidwood’s owners.”
Sterling N. Ransone, Jr., MD, FAAFP, president of the American Academy of Family Physicians, said in a statement that “family physicians are alarmed” by the decision.
“If today’s ruling stands, it will jeopardize health outcomes by creating financial barriers to screenings, counseling and preventive medications that improve our patients’ health,” Ransone said in the statement. “The AAFP calls on lawmakers, insurers and health plan sponsors to ensure patients can continue to access high-value, essential preventive services without cost-sharing.”
Reference:
- AAFP. https://twitter.com/aafp/status/1567627396748136448. Accessed Sept. 8, 2022.
- Braidwood Management Inc. et al. v Xavier Becerra et al. https://storage.courtlistener.com/recap/gov.uscourts.txnd.330381/gov.uscourts.txnd.330381.92.0_4.pdf. Accessed Sept. 8, 2022.
- Complaint – class action. https://s3.documentcloud.org/documents/22276221/kelley-v-azar-complaint.pdf. Accessed Sept. 8, 2022.
- Denial of Coverage for PrEP is Dangerous and Unacceptable. https://www.hivma.org/news_and_publications/hivma_news_releases/2022/denial-of-coverage-for-prep-is-dangerous-and-unacceptable/. Published Sept. 7, 2022. Accessed Sept. 8, 2022.