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Texas U.S. District Judge rules employers not required to include PReP in insurance coverage

A Texas U.S. District Judge, Reed O’Connor, ruled that employers in the United States are no longer required to provide the HIV-preventative drug, PrEP, under the Affordable Care Act. The decision means that over 150 million Americans on employer-sponsored health plans will lose some cost-free coverage for the drug. The ruling stemmed from a case brought by six individuals and two Christian-owned businesses who argued that they should not be mandated to offer coverage of PrEP because they did not want to encourage “homosexual behavior.”

Last September, O’Connor ruled that the ACA’s PrEP mandate was unlawful, which required insurers and employers to offer plans that covered HIV-prevention measures such as PrEP for free. The ruling was based on the Religious Freedom Restoration Act, which ensures that interests in religious freedom are protected. Thursday’s ruling invalidated recommendations issued by the U.S. Preventive Services Task Force regarding the required provisions for preventive care treatments under the ACA.

Under the ACA, most health insurance plans must cover certain recommended preventive services, including HIV testing for people aged 15-65 and HIV PrEP for adults who are at high risk of getting HIV. However, with this ruling, employers are no longer required to cover PrEP for their employees, leading to concerns about access to the drug for those who cannot afford it.

The ruling affects more than just the coverage of PrEP; other preventive services, including immunizations, contraception, cancer screenings, and some screenings for heart disease, cervical cancer, diabetes, and breast cancer, will no longer be covered under the ACA. While some services, such as vaccinations for the flu, hepatitis, measles, shingles, and chickenpox, well-woman and well-child visits, and certain free preventive services for children and women, will continue to be covered.

It is expected that the Biden Administration will appeal the ruling as access to PrEP is crucial to the prevention of HIV, particularly for communities that are disproportionately affected by the disease, such as men who have sex with men, people of color, and those in low-income communities.

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