A Florida-based grocery chain is denying insurance coverage for the HIV-preventative drug, PrEP, for at least one of its employees.
PrEP – which stands for pre-exposure prophylaxis – is more than 90 percent effective at preventing the transmission of HIV.
The medication, known by the brand name Truvada, is covered by government-provided insurance through Medicaid and many private insurers.
Publix employees are insured through Blue Cross Blue Shield Florida and the company claimed that it does not provide coverage for conditions that have not been diagnosed and that they have ‘no indications’ of.
Publix, which has more than 1,000 grocery stores in the Southeastern US, is cryptically denying its employees insurance coverage for HIV prevention medications
One of the grocery store chain’s 188,000 employees was denied coverage for his PrEP prescription, which costs $1,300 a month without insurance.
But the drug’s cost is still far less than the expense of HIV treatment, notes Damon Jacobs, a therapist, PrEP educator and founder of the online community PrEP Facts: Rethinking HIV Prevention and Sex.
‘Preventing HIV is about a third of the cost of treating it, so it would be ignorant – even if they don’t care about our lives, sexuality or bodies – [to not cover PrEP] because the fiscal difference between prevention and treatment is significant,’ he says.
After the company’s initial denial, the employee appealed twice more, but still Publix would not budge.
Jacobs says: ‘PrEP has not been regularly denied in this country, except by Christian-based companies like Hobby Lobby, which won the ability to deny birth control and PrEP because of morality,’ in a 2014 Supreme Court case.
WHAT IS PrEP? THE HIV PREVENTION DRUG THAT STOPS 90 PERCENT OF TRANSMISSION
This drug in particular is fixed-dose combination of two anti-retroviral drugs, tenofovir and FTC, in one pill.
They work together to interfere with an enzyme which HIV uses to infect new cells, slowing down the virus’s attack or preventing it altogether.
The drug is designed for people that have not yet been exposed to the virus to protect themselves against it.
Alternatively, people who have been exposed can take PEP (post-exposure prophylaxis), a month-long course of drugs started within 72 hours of exposure.
Publix is known throughout the South for its cheery Christmas commercials, as well as a religious discrimination lawsuit the company faced last year after one of its stores told a newly-hired employee he would have to cut off his dreadlocks – which was against his religion – in order to work there.
Its mission statement claims that the company believes that ‘diversity is a good thing,’ and hires employees of all backgrounds. It is relatively well-rated on Glassdoor.com and praised for its affordable health care plans.
Jacobs suspects, however, that Publix’s denial of PrEP coverage falls into the ‘malicious’ category, rather than a choice made out of ignorance of the pill’s cost-effectiveness.
If this is the case, ‘this is just outright cruelty.
‘I would say [it is] a phobia, but, especially in the South, PrEP offers women the ability to protect their bodies…when they don’t always have full control over whether male partners are using condoms,’ Jacobs says.
He adds that Publix is a major employer in four out of ten of the cities in the US with the highest annual rates of new HIV diagnoses: Miami, Jacksonville and Orlando, Florida, and Columbia, South Carolina.
In Florida, Blue Cross Blue Shield covers preventative screening and vaccinations, including the preventative shot for the sexually transmitted human papillomavirus (HPV), given to girls and women who test negative for the virus.
But the insurer’s guidelines only specify that it covers HIV testing and counselling for its customers, free of charge, making no reference to any HIV prevention medications or measures.
PrEP is more than 90 percent effective at preventing HIV transmission, but insurance coverage for the drug falls into a legal gray area
In October of last year, the Trump administration did away with a legal requirement for employer-provided healthcare plans to cover birth control, making it possible for any company to claim exemption on religious or moral grounds, sparking uproar among American women and reproductive rights groups.
Although PrEP has been around for more than a decade, they have not been adopted as widely as public health experts had predicted, so laws and regulations surrounding the drugs are still somewhat under-developed.
The Obama administration established a rule that all employers had to provide insurance coverage that allowed women access to birth control, excepting ‘churches and religious employers.’
After Truvada was was approved for PrEP by the Food and Drug Administration in, Medicaid automatically approved it in all 50 states.
Beginning in 2014, in order to compete in the market place under the Affordable Care Act (ACA), insurers had to comply with the health care reform’s requirements, including expectations that they not discriminate in any way.
‘This also meant that they couldn’t discriminate against you if you are HIV negative and on PrEP,’ Jacobs says.
There haven’t been any legal challenges so car. ‘Any time an insurance company through ACA tried to deny use of PrEP, the media got involved, the person appealed and won,’ Jacobs says.
This means that Publix is positioned to set an important precedent.
If Publix is covering Truvada for people living with HIV, ‘which they are, it seems like a clear cut discrimination case that they are denying people who are negative access to the same thing,’ Jacobs says.
‘The nation’s spotlight is on them right now, and, if they want to, they could use this to take a profound stance and say that they’ve heard the feedback, reconsidered and are going to cover PrEP for employees.
‘So when the epidemic is over, [Publix] can say that they played a major role in ending it by making PrEP available in cities where new diagnoses are most prevalent,’ Jacobs says.