Illinoisans accessing pre-exposure prophylaxis (PrEP) should have no disruption to insurance coverage following a federal court ruling on March 30 striking down an Affordable Care Act (ACA) rule that PrEP be paid for by insurers without patient cost-sharing.
But the ruling, handed down by Judge Reed O'Connor of the Northern District of Texas in Braidwood Management v. Becerra, now means that advocates and service providers even in Illinois must be extra-vigilant to ensure that the current of level coverage cannot suddenly stop if there is a shift in the state's political landscape, said Omar Martinez-Gonzalez, senior manager of Policy & Advocacy at AIDS Foundation of Chicago (AFC).
Martinez-Gonzalez called the federal ruling "enraging." O'Connor essentially agreed that the plaintiffs, a group of Christian-owned businesses and several individuals, would be unduly burdened by having to cover PrEP through their employee insurance programs. The plaintiffs maintain their anti-LGBTQ+ religious principles would have been in conflict with the presumption that employees using PrEP would be engaging in same-sex sexual activity.
In January, Gov. J.B. Pritzker signed HB 4664, the Patient and Provider Protection Act, an omnibus bill that, among other rules, directed insurance providers to pay for PrEP without patient contribution. Various reproductive health and gender-affirming care services were also addressed by HB 4664.
"In the immediate future, PrEP is covered for Illinoisans, but, as you can imagine, that can change if decision-makers change in the future," Martinez-Gonzalez said. "Elected officials who oppose PrEP could potentially repeal that law. Without robust federal protection, access to PrEP could be jeopardized in the long-term."
PrEP features heavily in the state's Getting to Zero Illinois initiative, which is targeting the elimination of new HIV transmissions in the state by the year 2030. That goal has already been frustrated by challenges from linking PrEP resources to communities that need them most, he added.
"I worked previously in the field, doing HIV-counseling in linkage to PrEP services," Martinez-Gonzalez said. "Given all the barriers we were experiencing then trying to link [patients] to PrEP, and given the COVID-19 pandemic, linkage to care was severely hindered. This is just another injury to our communities and bringing them access to life-saving medication."
He additionally noted that people of color—among them same-gender loving men, transgender women and cisgender heterosexual women—are the communities most at risk of HIV transmission, and all lag in access to PrEP care and services.
"This just creates another barrier of care for these communities," Martinez-Gonzalez added.
Despite HB 4664's various protections, all Illinoisans, like all other Americans, are now at risk for having to pay towards their coverage for numerous other preventative services, such as breast cancer screenings, STI screenings and influenza vaccinations, among many others.
"The lawsuit was initially aimed at PrEP coverage, but the decision goes beyond that," Martinez-Gonzalez said. "It really strikes down that key provision of the ACA which allows for other prevention services [without patient-payment] recommended by the U.S. Prevention Services Task Force."
Martinez-Gonzalez handles AFC's national outreach, so he'll be working with national partners to "think about solutions we can take in providing PrEP access at the federal levels. We're obviously encouraging the Biden administration to appeal this decision, so we'll be doing whatever we can at the national level to ensure that PrEP remains accessible to all Illinoisans."
