Controversy over insurance cover for PrEP

Bureaucracy stood in the way of gay man in British Columbia who wanted insurance cover

Controversy is swirling after a story broke about a young gay man from Vancouver who was searching for insurance cover for Truvada.

Daily Xtra has reported on the case of a man named Dan who wanted to gain access to the pre-exposure prophylaxis drug before a trip to the USA. He thought that a month would be enough time to speak to his doctor and get the cover he needed – however, the process took much longer than expected.

In fact, he was rejected on two occasions and it eventually took more than two months before Dan was finally able to get the coverage he needed. He was so frustrated by the experience that he decided not to get a prescription and instead get some Truvada from an acquaintance.

According to the report, Dan’s case is certainly not the only one in British Columbia. Even though insurance companies should theoretically cover the drug, the reality is that gay men are often rejected and there is a lot of misinformation about the cover. Some insurers have stated that they do not cover “preventative medication” – but at the same time, they offer coverage for birth control.

The drug has not yet been approved for HIV prevention by Health Canada – it has only been approved for HIV treatment. As a result, doctors have to prescribe it “off label” and for a use that it is not officially intended for. It is actually even more difficult in British Columbia because the province will give the drug for free to those who are already affected.

The report suggests there is confusion about where the responsibility lies – with insurers responding that employers need to ensure it is included in health plans and the Canadian Life and Health Insurance Association insisting that the confusion is not intentional.

Do you think insurers should offer cover for Truvada as a preventative drug? Leave a comment below with your thoughts.

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