Jul 26, 2022 - Health

ACA lawsuit puts HIV PrEP coverage in danger

HIV prevention drug Truvada.
HIV prevention drug Truvada. Photo: BSIP/Universal Images Group via Getty Images

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

Driving the news: Jonathan Mitchell, Texas' former solicitor general who helped write 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 interests in religious freedom are protected."

  • Mitchell's clients include two businesses and several Texas residents who object to the mandate on religious grounds, Bloomberg reports.
  • The law is often used in legal cases challenging abortion and contraception access, as well as health care for transgender people, per Bloomberg.
  • HIV PrEP is more than 90% effective in preventing the transmission of HIV.

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 homosexual behavior, drug use, or sexual activity outside of marriage between one man and one woman."

  • This "unquestionably qualifies as a 'substantial burden' on the exercise of their religion."

Context: Under the ACA, most health insurance plans must cover certain recommended preventive services, including HIV testing for people aged 15-65 and HIV PrEP for adults who are at high risk of getting HIV.

  • In 20212, the FDA made Gilead's Truvada the first approved drug for HIV prevention in uninfected adults.
  • In 2019, the U.S. Preventative Services Taskforce recommended PrEP as an effective method of preventing HIV, meaning health plans had to make it available at no cost to patients under the ACA in January 2021.

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

Editor's note: This headline and article have been corrected to note that Jonathan Mitchell is the state's former solicitor general, not the sitting one. The lawsuit is being brought by private citizens, not the state of Texas.

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