Government cannot mandate coverage of drugs that prevent HIV infections, Texas federal judge says

A Texas federal judge has ruled that a provision of the Affordable Care Act that mandates free coverage for certain drugs that prevent HIV infections violates the religious beliefs of a Christian-owned business.

U.S. District Judge Reed O’Connor’s decision came in response to a lawsuit filed by former Texas Solicitor General and conservative activist Jonathan Mitchell on behalf of Braidwood Management Inc.

The lawsuit challenged a provision of the ACA that required free coverage of the anti-HIV drugs Truvada and Descovy, commonly known as PrEP, which hundreds of thousands of Americans — mostly gay and bisexual men — are taking it.

O’Connor sided with the company.

“Defendants do not show a compelling interest in forcing private religious companies to cover PrEP drugs without cost sharing and without religious exemptions,” the judge said.

HIV prevention groups were quick to denounce O’Connor’s decision as a “terrible court ruling”.

“This decision is shocking on every level,” said Mitchell Warren, executive director of the HIV nonprofit AVAC. “This defies evidence, logic, public health and human rights and sets back huge progress in the fight to end the HIV epidemic.”

PrEP is a “central element” in the fight against the spread of HIV, Warren said.

O’Connor, an appointee of former President George W. Bush who called the ACA unconstitutional, has in recent years become the go-to judge for conservatives seeking to challenge Obamacare provisions and measures aimed at protect transgender students and enforce Covid vaccine mandates.

Mitchell is best known as the architect behind a Texas law that encourages people to sue those suspected of helping women get abortions.

The Food and Drug Administration approved Gilead Sciences’ Truvada antiretroviral tablet for use as PrEP in 2012. Daily use of the tablet reduces the risk of contracting HIV by more than 99% in men who have sex with men and at least 90% in women. .

The FDA approved a second Gilead tablet, Descovy, for use as PrEP in 2019.

In 2019, the U.S. Task Force on Preventive Services gave PrEP what’s called an “A grade,” which under the ACA means the vast majority of insurers were required to cover free HIV prevention from January 2021.

However, recent analyzes indicate that not all insurers in the country adhere to this policy. And it has raised concerns among public health experts that such direct costs will hinder the use of PrEP.

“Increasing access to PrEP in the United States has been a key public health goal, and requiring private insurers to provide PrEP without cost sharing has been a key way to promote access” said Jennifer Kates, director of global health and HIV policy at the Kaiser Family Foundation. “However, this latest decision would reintroduce a barrier that would result in reduced access, as fewer people would be able to afford this essential procedure.”


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