opinion | Why PrEP Should Be Covered for Free (Especially in Texas)

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An ounce of prevention is worth a pound of cure. As an HIV doctor in central Texas, I know that nowhere is that saying more true than in the case of pre-exposure prophylaxis (PrEP), a drug that up to 99% effective in preventing HIV. A recent verdict in a federal court in Texas has the potential to threaten not only PrEP, but access to all common sense preventive medical care for people in the US

A recent ruling in a federal court in Texas could threaten not only PrEP, but access to all common-sense preventive medical care for people in the U.S.

On Wednesday, a U.S. district court ruled in favor of Braidwood Management Inc., a Christian-owned company that owns its… first complaint that the Affordable Care Act’s requirement that insurers and employers offer plans that cover PrEP for free “forces religious employers to provide coverage for drugs that facilitate and encourage homosexual behavior, prostitution, sexual promiscuity, and intravenous drug use.”

Not only is this argument terribly biased, but it’s just plain wrong. PrEP is used by hundreds of thousands of people in the US of all sexual orientations and genders. I see many patients, young and old, gay and straight, of all races and political affiliations, who don’t fit the scary stereotypes mentioned in the lawsuit.

I have patients who are in a long-term monogamous relationship and who use PrEP because their spouse or partner has HIV and they want an extra layer of protection. Others take PrEP to make sure they are protected and in control of their health rather than relying on someone else. Some have been attacked in the past and want to make sure they are protected in the future. All these patients can now live their lives with more peace and confidence, and they would be devastated if access to these drugs were taken away.

None of these people deserve to be stigmatized or refused services that give them peace of mind and control over their health.

The federal government is expected to appeal the ruling. But if confirmed, it will tragically hold back the progress we’ve made in the fight against HIV. It will increase the number of people living with HIV in Texas, a state that is already alive overloaded with large numbers of uninsured patients.

Travis County, where I practice, is one of the 50 high priority jurisdictions in the country with a high number of new HIV diagnoses. Texas is home to five such counties and, according to the Centers for Disease Control and Prevention, ranks number two in the nation for new HIV diagnoses. Studies show that increasing access to PrEP reduces HIV for the entire community.

When not covered by insurance, PrEP Cost run from $60 per month for a generic form of the drug to $2,000 for a 30-day supply for brand-name formulations, one of which should be used for patients with certain conditions such as kidney disease. The cost of PrEP, along with the cost of doctor visits and labs, makes it inaccessible to most people without insurance. And coverage of PrEP is a worthwhile investment that will help lower health care costs nationally, because paying for HIV treatment – which a person needs for a lifetime – even more expensive.

The labels that Braidwood Management Inc. used in her lawsuit are a way to weaponize stigma against sex, gay men and IV drug users — like a Trojan horse, they disguise a larger target of attacking preventive care coverage. And that should concern all of us. The Affordable Care Act requires insurers to cover medications and procedures recommended by the U.S. Preventive Services Task Force (USPSTF), those with the strongest evidence for improving low-risk health. PrEP is on that list and is just one of many extremely valuable tools that doctors like me have to prevent the spread of disease and limit suffering. Other USPSTF recommendations include colon cancer screening and medication to prevent eye infections in newborns. This lawsuit could be a gateway to an erosion of personal and public health by blocking the most drastic interventions to prevent disease, resulting in unnecessary suffering and lost lives.

Using stigmatizing language makes it easier to refuse services and lowers costs for insurers, to the detriment of all of us. With American life expectancy falls and health care costs rise, we should all be concerned about the implications of this ruling. If we hinder our ability to prevent disease, our nation will grow sicker and weaker. To achieve a cure, we need more preventive tools like PrEP, not less.



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