“I was truly shocked,” he added. “PrEP is usually the responsible thing to do. This particular’s the closest thing we have to an H.I.V. vaccine.”
Unable to get the company to change its decision — even after he offered to sign a waiver voiding his policy should he become H.I.V.-infected — he did what some some other gay men in similar situations have been forced to do. He stopped taking Truvada.
He then applied to a different insurer — along with was offered a lifetime disability policy.
There are nearly 800 life insurers in This particular country, according to the American Council of Life Insurers. There are no national figures on how many of them have denied coverage to men because they take PrEP.
although insurance brokers, gay-rights advocates along with staff at medical clinics said in interviews they had heard of numerous such cases. H.I.V. specialists say the denials endanger men’s lives by encouraging them to drop PrEP if they need life, disability or long-term-care insurance.
By contrast, health insurance companies usually cover PrEP, which the Centers for Disease Control along with Prevention endorsed in 2014 for anyone at substantial risk of H.I.V., which includes any gay or bisexual man who might have sex without a condom with anyone of unknown H.I.V. status.
The denials turn the insurance industry’s risk-management standard on its head: men who do not protect themselves can get policies, while men who do cannot.
“This particular doesn’t make any sense,” said Dr. Anthony S. Fauci, director of the National Institute of Allergy along with Infectious Diseases, along with perhaps the nation’s best-known AIDS doctor. “This particular ought to be the some other way around.”
Dr. Robert M. Grant, the AIDS researcher at the University of California, San Francisco, who led the clinical trial of which established the value of PrEP, said such denials “truly are silly — This particular’s like refusing to insure someone because they use seatbelts.”
Moreover, advocates argue, the practice singles out gay men for discriminatory treatment. Women, for instance, are not denied coverage if they use birth control pills or get the vaccine against human papillomavirus, which can cause cervical cancer. Yet like Truvada, use of these drugs suggests an active sex life, with the accompanying risks.
along with insurers routinely cover applicants with actual diseases controlled by medications, including diabetes, epilepsy, high blood pressure along with bipolar disorder.
Bennett Klein, a lawyer for GLAD (GLBTQ Legal Advocates along with Defenders), based in Boston, said he knew of 14 instances in which companies denied life insurance, long-term-care insurance or disability insurance to gay men on PrEP, or told brokers they might do so if asked.
Courtney Mulhern-Pearson, policy director for The San Francisco AIDS Foundation, said denial of life insurance to men on PrEP was “an increasing trend.”
When companies did offer explanations, they said applicants were turned down because the company believed they must be engaging in high-risk sexual behavior.
When she explained to some insurers of which PrEP was protective, regardless of behavior, “there seemed to be an understanding,” she said. “although so far I haven’t seen any policy adjustments.”
The foundation considers the practice discriminatory, along with Ms. Mulhern-Pearson has requested a meeting with California’s state insurance department “to see if there’s anything we can do legislatively or through regulation.”
The Times contacted the A.C.L.I., the industry’s trade association, along with four of the companies named by Mr. Klein, sending each detailed questions about underwriting policies related to Truvada along with the sexual habits of applicants, along with what some other medical conditions caused them to deny coverage.
An A.C.L.I. spokesman said the council did not collect such information through members.
For competitive reasons, companies do not publicize their underwriting standards along with often do not explain why they deny an individual policy. Each policy is usually denied — or offered at a higher cost or shorter term — based on many medical factors, including weight, blood pressure, cholesterol, smoking status along with so on.
Mutual of Omaha, which Mr. Klein is usually suing for denying long-term-care insurance to an unnamed gay man, declined to answer any questions along with said This particular did not comment on pending litigation.
In motions filed in GLAD’s suit, Mutual of Omaha conceded of which This particular had denied an applicant coverage because he took Truvada.
The drug is usually indicated only for persons with H.I.V. or at high risk of acquiring H.I.V., the company said. Therefore This particular turned down everyone taking Truvada.
“The fact of which the drug is usually less than 100 percent effective adds yet another layer to the risk profile,” the company added.
According to internal underwriting guidelines obtained by Mr. Klein, Mutual of Omaha sells long-term-care policies to people with Addison’s disease, bipolar disorder, depression, mild coronary artery disease, diabetes, epilepsy along with high blood pressure, as long as they are controlled by medication for various periods, through six months up to three years.
This particular also insures former alcoholics who were alcohol-free along with in support groups, as well as people who had recovered through heart valve surgery or cancers of the bladder, breast, prostate along with skin.
“The irrationality is usually enough to make your mind spin,” Mr. Klein said.
some other insurers replied to The Times’s questions with brief answers saying they did not deny coverage solely for taking PrEP although declining to describe what conditions or behaviors might cause them to exclude coverage.
A spokesman for Lincoln National Life, in Fort Wayne, Ind., said This particular had approved policies for men on PrEP along with had offered some lower rates reserved for low-risk clients. A spokesman was unsure when the company began doing so.
A spokeswoman for Principal National Life in Des Moines said the company “doesn’t decline individuals just because they’re taking Truvada” along with did not quiz applicants about their sexual history. She declined to answer further questions.
A spokeswoman for Protective Life Insurance of Birmingham, Ala., said This particular “did not deny coverage based solely on Truvada use,” along with might even offer a low-risk rate to someone taking the drug. She, too, declined to answer further questions.
Mr. Klein said he had sometimes heard similar answers through insurers even as men are denied coverage.
“I am fairly certain of which This particular is usually just slippery language, along with of which they are excluding applicants when they see a diagnosis of ‘high risk sexual behavior’ or ‘exposure to H.I.V.’ in an applicant’s medical record.”
Those descriptions are linked to diagnostic codes of which doctors use for reimbursement through health insurers when a patient asks for a prescription for Truvada. “of which’s no different through excluding based on PrEP usage alone,” Mr. Klein argued.
Aaron E. Baldwin, a financial planner in San Francisco who specializes in clients living with H.I.V., said he had been seeing such denials for three years.
Some clients denied coverage, he said, were young executives with large student debts who wanted insurance to ensure should anything happen to them, their parents might not be saddled with payments.
In his experience, Mr. Baldwin said, companies in Midwestern along with Southern states were reluctant to insure men taking Truvada, while completely new York Life, for example, insured even men with H.I.V. as long as they could show they took their medications every day.
In his case, Dr. Cheng said, a broker told him of which the insurer claimed to be unsure about Truvada’s side effects. although the drug was approved by the Food along with Drug Administration in 2004, along using a study published in 2016 concluded of which This particular was safer for long-term use than aspirin, which can cause gastrointestinal bleeding.
Dr. Cheng is usually right now in a long-term relationship with an H.I.V.-negative man, along with so he no longer takes Truvada. although the sting of his insurance denial lingers.
“This particular was blatant discrimination,” he said.
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