Texas Ruling on HIV PrEP Could Impact Other Preventive Coverage

A Texas judge ruled that coverage for HIV pre-exposure prophylaxis (PrEP) violates religious freedom but there is concern that cancer screenings and other preventive services could be affected.

A federal judge in Texas ruled that Affordable Care Act provisions that require private insurance plans to cover HIV prevention drugs violates federal law and the Constitution. U.S. District Judge Reed O’Connor found that the HIV pre-exposure prophylaxis (PrEP) mandate could infringe upon the rights of employers under a law called the Religious Freedom Restoration Act, Reuters reported.

But groups such as the American Cancer Society Cancer Action Network (ACS CAN) argue other preventive services, including screenings for breast, colorectal, cervical, and lung cancer, could be impacted by the ruling.

“This ruling threatens to erode more than a decade of progress reducing cancer deaths and suffering. Having guaranteed, no-cost coverage of proven preventive and screening services — like those for breast, colorectal, cervical, and lung cancer — has enabled more people to get timely, life-saving screenings without facing potentially unaffordable out-of-pocket costs,” Lisa Lacasse, president of the American Cancer Society Cancer Action Network, said in a statement.

“Research has repeatedly shown the benefit of these screenings in both lives and dollars saved. Before the passage of the Affordable Care Act, high costs and unclear coverage were repeatedly cited among the top reasons people delayed or skipped screenings. We cannot risk returning to a system wherein every individual has to interpret their complex insurance plans to determine if a recommended mammogram will be covered or to determine how much their colonoscopy may cost,” Lacasse added.

ACS Can is urging the government to appeal the ruling. “Cancer patients, survivors and all those at risk for the disease cannot face undue barriers around cost and coverage of these services. Such changes would be especially concerning when screening rates continue to be unacceptably low, largely due to the pandemic.”

The legal challenge was filed in 2020 by eight individuals and two businesses in Texas and the conservative America First Legal Foundation is helping to represent the plaintiffs, according to Reuters.

“They argued that the free PrEP requirement, as well as free coverage requirements for contraceptives and the human papillomavirus (HPV) vaccine, requires business owners to pay for services that ‘encourage homosexual behavior, prostitution, sexual promiscuity and intravenous drug use’ despite their religious beliefs,” Reuters said.

O’Connor has not yet ruled on the challenge to the contraceptives mandate and rejected the challenge to the HPV vaccine mandate, according to Reuters.