Sep 8, 2022 - Health

Court ruling on HIV meds could have sweeping implications for preventive care

Illustration of a caduceus turning into a gavel.
Illustration: Brendan Lynch/Axios

A federal court ruling that struck down required coverage of HIV prevention medication may have far more sweeping implications for whether insurers will have to continue offering a range of no-cost preventive health services.

Driving the news: U.S. District Court Judge Reed O'Connor ruled on Wednesday that an Affordable Care Act requirement that employers cover the HIV prevention medication known as PrEP violates the Religious Freedom Restoration Act.

What he's saying: The government failed to show "a compelling interest in forcing private, religious corporations to cover PrEP drugs with no cost-sharing and no religious exemptions," O'Connor wrote.

  • O'Connor also said the U.S. Preventive Services Task Force violates the Appointments Clause of the Constitution, casting into doubt its recommendations about how primary and preventive care is delivered, along with which services should be paid for by insurance.
  • PrEP is among the services the task force most highly recommends. Other services include screening for breast, lung, colorectal and cervical cancers, fall prevention for older adults, depression screening and certain prenatal care services and infant screening services.

What they're saying: "This is not just about PrEP. It's much broader," Katie Keith, a health law expert at Georgetown University told Axios.

  • "If we l0se the A or B recommendations, then any employer or plan, religious objection or not, could say we're not going to cover that anymore."
  • Jonathan Adler, a Case Western Reserve University law professor, agrees. The ruling suggests "self-insuring employers could pick and choose what they want to cover based on religious objections to certain types of coverage."

What to watch: There's still some uncertainty about the scope of the ruling, Keith said. O'Connor told both sides to file briefs addressing that by Friday.

  • If it does apply more broadly, experts say it would strike at the heart of the ACA's preventive services mandate and could put millions of Americans on the hook financially for some of the highest-value services.
  • "Adding an additional barrier to so many essential medical services is only going to make things worse and it's going to make things disproportionately worse for the most vulnerable," Mark Fendrick, director of the University of Michigan Center for Value-Based Insurance Design told Axios.
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