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Federal judge rules against HIV prevention drug insurance mandate, worrying some Texans

A statewide clinic says it will help those without coverage find affordable options.
Kind Clinic
Posted at 6:08 PM, Sep 08, 2022
and last updated 2022-09-08 19:08:33-04

A federal judge from Texas ruled against a mandate requiring insurers to cover HIV prevention drugs on Wednesday. A Texas sexual health clinic plans to continue helping those without insurance find affordable options.

The Kind Clinic, a program of the non-profit Texas Health Action, helps connect patients to free access to PrEP, or pre-exposure prophylaxis. PrEP is a daily HIV prevention drug, which insurers and employers were required to cover under the Affordable Care Act.

Wednesday's ruling, however, struck down that mandate. U.S. district court judge Reed O'Connor sided with a group of Christian employers in a lawsuit that called the mandate a violation of religious freedom.

Colton Ferrell, a patient of the Kind Clinic, has been using PrEP for eight years.

"A medication for my health doesn't violate anyone's religious freedom," Ferrell said. "Not to mention there are plenty of people who take prep who are not gay or bi or queer."

When he first started taking PrEP, Ferrell said he had difficulty getting his insurance to cover the cost.

"There were many calls both back and forth with my doctor and with the insurance company, trying to get this covered," he said.

Ferrell said he worries that the ruling will create confusion for patients as they try to clarify if their insurer still covers the drug.

PrEP has become more commonly used in recent years. Preliminary CDC data estimates that in 2020, 25% of the 1.2 million recommended to take the medication were prescribed it. That number was just 3% in 2015. In that same time period, HIV infections fell about 8%.

CEO of Texas Health Action, Christopher Hamilton, said the Kind Clinic will continue to work with patients to find ways for them to access the medication.

"This is a significant improvement in our ability to reduce and eliminate HIV transmission in the United States," Hamilton said of the drugs. "So taking away the ability for people to access this medication is just going to make the HIV epidemic worse.”

The Kind Clinic operates clinics in Dallas, Austin and San Antonio, as well as a telehealth service.