United Healthcare, one of the largest medical insurance companies in the U.S., sent a letter to a gay man in July that activists are calling out for blatant discrimination — and it's not hard to see why.
The full letter is posted in three photos on a Facebook post from James Krellenstein, who is a member of ACT UP NYC and posted on behalf of the letter's recipient (who wishes to remain anonymous.) The letter says, "the request for coverage for Truvada is denied. This decision is based on health plan criteria for Truvada. The information sent in shows that you are using this medicine for High risk homosexual behavior."
The letter came after the man was prescribed Truvada by his doctor. Truvada is a Pre-exposure prophylaxis (PrEP) drug, which means that it's specifically meant for people at high risk of contracting HIV (such as those in a relationship with someone who has the virus and men who have sex with men). Unlike most medications, for which a doctor writes a prescription and then you can pick it up at your pharmacist, Truvada is among a few drugs that require prior authorization.
Medications that need prior authorization require the patient's doctor to fill out a form describing why they need the medication that's prescribed. In this case, the doctor had to tell the insurance company that this man was gay and therefore at high risk of contracting HIV.
"There are very few cases that show black and white discrimination against a person for sexual orientation, but this is one of them," Krellenstein tells Refinery29.
The letter later states that Truvada is approved to "reduce the risk of sexually transmitted HIV-1 infection in adults at high risk," which Krellenstein says is further evidence that this man was denied the drug simply because of his sexual orientation. "It's apparently just gay sexual exposure that's not allowed," he says.
"The drug is designed for people at high risk for exposure," Krellenstein says. "Gay men, trans women. That’s what makes this so infuriating. This patient is attempting to protect himself, but because he was honest with his doctor, he was discriminated against. And this is just one person we found out about…how many more cases are there?"
United Healthcare released a statement about the letter, apologizing for the poor choice in language.
"We apologize for the insensitive language appearing in the letter and regret any difficulty it caused. We have corrected our letters, removed the prior authorization requirement for Truvada and members can fill their prescription at the network pharmacy of their choice," the company said in a statement shared with Refinery29.
Krellenstein said that even before United decided to remove the prior authorization needed to get coverage for PrEP, that it's likely this patient would have appealed and been able to get coverage for his medication, but that that's not the point.
"There’s absolutely no reason to deny someone this drug. It's not toxic or addictive. The only reason to dis-incentivize people from taking Truvada is for the insurance company's profit margin. They cannot be using arbitrary and exclusionary criteria to determine who gets access."
In his Facebook post, Krellenstein called for people to sign a letter to the New York State's Health Commissioner to investigate this incident and hold United Healthcare responsible.
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