UnitedHealthcare Plays Games with Gay Men’s Health | National | News | SFGN Articles – SouthFloridaGayNews.com
Michael Nemerof, 35, has been using PrEP for several years. Like many gay men he used Truvada to prevent HIV.
But when Descovy was introduced for PrEP his doctor recommended switching since he had experienced elevated liver enzymes on Truvada.
It worked.
But then the attorney, who lives in Wilton Manors, switched jobs and with that came a new insurance company — UnitedHealthcare. Despite already being on Descovy, UHC denied him the drug. Instead they wanted him to take a generic form of Truvada.
“[UHC] gave me a huge runaround,” Nemerof said. He said UHC kept sending denial letters for coverage of Descovy.
Nemerof isn’t alone.
It was reported last year in August UHC would no longer cover Descovy and would force their members to switch over to the generic form of Truvada. They said Descovy would then be subjected to prior authorization.
That did not sit well with Nemerof. He said he went back and forth with the insurance company for weeks. Eventually though they approved the new drug.
South Florida PrEP providers like Care Resource and Latinos Salud report that denied coverage and preauthorization has been an issue for some of their clients.
Nemerof said he eventually enlisted the help of Latinos Salud and after some time had his medical exception approved by UHC. He’s now taking Descovy.
SFGN requests for comment from a UHC spokesperson were not returned.
Both Truvada and Descovy were developed by Gilead Sciences and are highly effective at preventing HIV. Truvada was approved for PrEP in 2012 and has since changed the lives of many gay men and revolutionized HIV prevention. But from the beginning there were concerns about the long-term effects the drug would have on a person’s kidneys. Descovy though appears to have fewer side effects.
UHC members that were already on Descovy had to switch drugs unless they presented an approved medical exception. Some members had been on Descovy for some time — the U.S. Food and Drug Administration (FDA) approved it in late 2019.
“The rationale seems to be: If you have side effects you have to show it and get prior authorization for it from your doctor. However, this can take months,” Nemerof said.
He worries that the average person might just give up and stop taking PrEP — situation providers say they rigorously try to prevent.
“I’m an attorney and I’m used to the back and forth,” Nemerof said. “The layperson might get a denial letter and be taking something with a chance of greater side effects.”
Another UHC member John Anderson, who lives in Texas, was also denied Descovy. Like Nemerof, Anderson also had elevated liver enzymes while taking Truvada.
In March of 2020 he first switched to Descovy.
“I watched my labs go from elevated to borderline to normal in my most recent test. I believe that being forced by my insurance company to switch back to Truvada poses a risk to my liver health,” Anderson said. “For an insurance company and their ‘Licensed Board Family Physician’ with no name or face to tell me what I need above and against my [primary care provider’s] recommendations is just crazy.”
The process has left Anderson frustrated.
“Insurance companies are for profit and they serve their shareholders and their own interests first and foremost. That means that medical decisions they make are made with their financial interests at heart. When an insurance company consciously chooses to sacrifice ‘some’ safety to save cost by forcing someone to take one medication instead of another highlights this fact,” he said. “I know others who have argued with them for a month and were finally approved for Descovy. I feel like with some effort I can probably get it as well. The bottom line here is that they are making this extremely difficult and it shouldn’t be. Insurance companies should stick to paying for medication — not prescribing it.”
Ongoing Concerns
Stephen Fallon, CEO of Latinos Salud, said he’s seen clients go through the back and forth with insurance companies and doctors and that any given situation is complex and can be frustrating.
He said that while the move to generic Truvada was indeed based on financial incentives, he reiterated that the difference in side effects between the drugs is low.
“Most could take either drug; for most people Truvada is fine. However, Descovy does have advantages for those with kidney issues,” he said. “They’re half as likely to have problems.”
One other difference, Fallon said, is that Descovy appears to have a slightly stronger half-life, which could make a difference if “you’re not as perfect with dosing as you thought — it would be slightly more forgiving.”
He said one of the ironies is that those with insurance often got bumped to Truvada or the generic, but those without insurance could get Descovy, because Gilead Sciences gets reimbursed from the government the same way it would an insurer.
“It’s easier to get Descovy if you’re uninsured,” Fallon said.
That irony notwithstanding, Fallon said he and his staff are focused on high-risk populations that often lack PrEP access and coverage.
“What we’re working on is trying to get PrEP for people who are the least likely to receive it — that’s people of color in general. African Americans and Latinos by far lead the nation in new cases of HIV,” he said. “PrEP is mostly going to white, gay men. Don’t get me wrong — white, gay men should be on PrEP too.”
Fallon noted that the Centers for Disease Control report that only 21% of Hispanic/Latino gay and bisexual men take PrEP compared to 31% of white gay and bisexual men.
African Americans and Latinos had the highest HIV diagnosis rates, but only accounted for 8% and 9% of those on PrEP, respectively.
Contact Latinos Salud at latinossalud.org and Care Resource at careresource.org for more information.