June 27, 2019 at 9:18 am PST | by Staff reports
California Insurance Commissioner warns against denying PrEP coverage

(Photo via Flickr)

On June 20, California Insurance Commissioner Ricardo Lara put the state’s insurance companies on notice that discriminatory practices against HIV-negative individuals who used pre-exposure prophylaxis medication, or PrEP, to prevent contracting the disease, is unlawful. The notice is the result of a Department of Insurance investigation that uncovered evidence of discrimination against Californians who use PrEP.

The investigation found that some of these companies had denied or limited coverage, restricted products available through accelerated underwriting, placed conditions on coverage, or charged higher rates.

“PrEP prevents HIV, pure and simple, and I will not tolerate insurers violating California law by discriminating against people taking proactive steps to be healthy,” Lara stated in a press release. “The Department of Insurance warns insurers to stop discrimination against PrEP users and review their underwriting rules before we take action. As we celebrate Pride Month, ending HIV infections is within our reach. But first we have to eliminate prejudice and fear that still stands in the way of a cure.”

A department spokesperson told the Los Angeles Blade that there is a strong commitment to roll back barriers and prevent discriminatory practices by the insurers, especially in health care access issues. While the investigation did not find widespread patterns of discriminatory underwriting guidelines and practices, it determined that there had been cases in which some individuals’ ability to access the medication had been limited. The notice asks insurers to review their underwriting guidelines and practices to ensure they are not unlawfully discriminating against applicants.

On June 11, the U.S. Preventive Services Task Force recommended that people who are at a significant risk of acquiring HIV take PrEP. Under Federal guidelines, the recommendation means that private insurance companies will have to cover PrEP without cost-sharing for those individuals by 2021. Studies have shown that currently only 17 percent of those eligible for daily PrEP actually take it.

Meanwhile, California Sen. Kamala Harris, a Democratic candidate for president, introduced the PrEP Access and Coverage Act, legislation that would guarantee insurance coverage for PrEP and create a grant program to fund uninsured patients’ access to the medication.

Harris’ legislation goes further than the Preventive Services Task Force recommendation by requiring that all private and public insurance plans—including Medicare and Medicaid—cover access to PrEP without a copay, not only for the drug itself but also all associated doctors visits, tests, and monitoring recommended by the Public Health Service. 

The California Insurance Department’s spokesperson said that department staff will continue to review insurer compliance with the law and noted that individuals who believe they were or are subject to discriminatory underwriting practices can contact the Department of Insurance at 800-927-4357 for assistance. 

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