Insurer to Stop Denying Coverage Based on PrEP Usage, Following Discrimination Allegations

Mutual of Omaha will no longer deny coverage to individuals using pre-exposure prophylaxis (PrEP) for HIV prevention following allegations of discrimination in 2 separate legal settlements.

According to the Massachusetts Office of Attorney General Maureen Healey, an assurance of discontinuance filed on January 8, 2019, in Suffolk Supreme Court resolved allegations that since 2014, the insurer had routinely denied life insurance and long-term insurance policies to individuals taking emtricitabine/tenofovir disoproxil fumarate (Truvada, Gilead), the once-daily pill that reduces the risk of acquiring HIV by more than 90%.

As part of the agreement, Mutual of Omaha will make a $25,000 payment to the state and has revised its underwriting practices to ensure that it does not deny, rate, or otherwise take any adverse action against any Massachusetts resident who applies for any type of accident, life, sickness, or health insurance with the insurer, including long-term care insurance, based on the applicant’s use of PrEP.

Under terms of the settlement, the insurer will offer consumers who were previously denied coverage the ability to reapply for insurance under these revised guidelines. For those who qualify for insurance under the insurer’s current guidelines, Mutual of Omaha agreed to honor the premium rates in effect at the time of the consumer’s original application.

In a separate but related case, an unidentified man represented by GLBTQ Legal Advocates and Defenders (GLAD) settled with the insurer, who will issue a long-term care insurance policy to the man.

“Consumers looking to protect themselves from HIV transmission should not be excluded from buying insurance,” Healey said in a statement. “Under this settlement, Mutual of Omaha will provide relief to affected customers who faced this discrimination. We are pleased to join GLAD today in sending a message to insurance companies that these unlawful practices will not be tolerated.”

The settlements only affect Massachusetts residents and apply to the 1 insurer. According to AIDSVu—a project of Emory University and Gilead—in 2017, 64 of every 100,000 people in Massachusetts were PrEP users.

In February 2018, New York also began investigating insurers in the state to determine if they were following similar actions following an article from The New York Times alleging that a man was denied lifetime disability insurance and told he could only have a 5-year policy because he was taking Truvada. After being unable to change the insurer’s decision, he stopped taking Truvada, applied to a different insurer, and was able to get a lifetime disability policy. The article also alleged that various insurers around the country had denied policies to gay men taking Truvada.

In November 2018, the US Preventive Services Task Force issued a draft recommendation that clinicians offer PrEP to all people at high risk of acquiring HIV, stating the evidence is clear that when taken as prescribed, PrEP is highly effective at preventing HIV infection. The decision was applauded by the HIV/AIDS community as the decision was likely to expand coverage of the drug.

An earlier version of this article was published as, “Following Discrimination Allegations, Insurer Will Stop Denying Coverage Based on PrEP Usage,” on AJMC.com.