California Insurance Commissioner Ricardo Lara is warning insurance providers that they can't deny coverage to users of PrEP, the once-a-day pill that protects against HIV.
Lara, a gay man elected to the statewide office last year, issued the notice Thursday following a state Department of Insurance investigation into life, disability income, and long-term care insurance companies. It found that several companies had denied or limited coverage, restricted products available through accelerated underwriting, placed conditions on coverage, or charged higher rates to PrEP users.
The names of the companies are not being disclosed by the state agency because its findings are based on confidential market exams. According to the state insurance department, it has been advised by a number of insurers that they have discontinued such discriminatory practices.
"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," stated Lara. "The Department of Insurance warns insurers to stop discrimination against PrEP users and review their underwriting rules before we take action."
Since federal health officials in 2012 approved Truvada (tenofovir DF/emtricitabine) for use as pre-exposure prophylaxis there have been reports of users being denied insurance coverage. In January, Mutual of Omaha reached a settlement with the Massachusetts Attorney General's office after an investigation found the insurance company had routinely denied life and long-term care insurance policies to residents of the Bay State taking PrEP.
As the Bay Area Reporter noted at the time, the company agreed to no longer deny coverage to people using the HIV prevention medication and to offer affected consumers an opportunity to apply for insurance. Mutual of Omaha also settled out of court a lawsuit filed by GLBTQ Legal Advocates and Defenders on behalf of an unnamed plaintiff by issuing a long-term care insurance policy to them.
"We are pleased that Mutual no longer declines insurance coverage based on the use of HIV pre-exposure prophylaxis, and we call upon other providers of life, disability, and long-term care insurance to do the same," stated Bennett Klein, AIDS law project director for GLAD, at the time.
The June 20 advisory from Lara to insurers specifies that California law bars them from using a person's history of PrEP use as a justification to deny life, disability or long-term care insurance coverage or charge higher premiums for that coverage.
The notice also encourages insurers to review their underwriting guidelines and practices to ensure they are not unlawfully discriminating against applicants. It applies to all companies that sell life, disability, and long-term care insurance in California, which is the nation's largest insurance market.
The state's Office of AIDS estimates that as many as 240,000 Californians could be eligible for PrEP, but only around 9,000 people were using it as of late 2016. In San Francisco, about half of eligible individuals are on PrEP, according to the city's latest HIV epidemiology report.
The numbers are projected to increase in coming years. Earlier this month the U.S. Preventive Services Task Force called on health care providers to offer PrEP to men and women at high risk of acquiring HIV.
In Sacramento, lawmakers have advanced a bill that would allow pharmacists to furnish a 30-day supply of PrEP to people without a doctor's prescription for the medication. The state Senate passed the legislation, Senate Bill 159, in May and the Assembly is now reviewing it.
Lara's department will continue to review insurer compliance with the law when it comes to PrEP users. Anyone who believes they were subject to discriminatory underwriting practices due to their usage of PrEP can contact the Department of Insurance at 1-800-927-4357.
"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," stated Lara.