Council Speaker calls on city insurance plans to cover HIV-prevention drug it touts

Oct. 27--When the city rolled out statistics last year showing an all-time low rate of new HIV infections, it pointed to a drug that can drastically reduce the risk as the main reason -- and urged anyone at risk of contracting HIV to start taking it.

But some city workers who tried to heed their employer's advice and get a prescription for pre-exposure prophylaxis, often known as PrEP, were in for an unpleasant surprise: Some of New York City's health insurance plans do not cover the very drug its health department has evangelized.

"I was really taken aback and sort of shocked when I heard from city employees who told me that they were attempting to get PrEP through their health insurance and they were unable to -- it wasn't being covered," Council Speaker Corey Johnson, who is HIV-positive, told the News.

PrEP refers to preventative drugs that can be taken by people who don't have HIV, but are at risk of it -- and are increasingly being prescribed to men who have sex with men.

The city has made promoting PrEP a central focus of a $23 million investment in fighting AIDS, and has recently kicked off a campaign to get more at-risk women, whose HIV infections in the city have increased as men's have decreased, to take the drug.

"The city's investing tens of millions of dollars in ending the HIV and AIDS epidemic, while negotiating multi-billion-dollar labor contracts that don't cover PrEP," Johnson said.

To that end, he sent a letter to Labor Management Commissioner Bob Linn this month, following up on a previous one he'd sent in May.

"While New York Medicaid and most private insurance companies cover PrEP, lack of coverage under city health plans is glaring," he wrote.

In a statement, Mayor de Blasio's office said that coverage for the drugs is at the discretion of each union.

"We take the health care of our workers and their families very seriously. That's why this Administration made the first significant changes to the City's health plans in decades while also contributing to union welfare funds, which give most city workers access to medications like PrEP," spokesman Raul Contreras said.

"While coverage is ultimately at the discretion of the union, we'll continue doing all we can to encourage the few that do not cover this life-saving drug to begin doing so."

De Blasio's office said the unions determine which drugs are covered by the supplemental welfare funds. Employees whose unions don't have such funds have the option to purchase an optional rider that does cover PrEP and other HIV/AIDS medications at "modest copays," the mayor's office said.

But Johnson noted in his letter that employees whose unions have a welfare fund that doesn't cover PrEP can't purchase that rider -- making the cost of the medication prohibitive.

Johnson first became aware of the problem when a gay man from the Bronx who worked for the city contacted him about it, he said, and has since heard from others.

"He's HIV-negative and he reached out to me and told me that his doctor suggested that he go on PrEP, and then when he was prescribed it, it wasn't covered by his city health insurance program," Johnson said.

In his letter, he suggests the city could add PrEP and other HIV/AIDS treatments to a city program that ensures that all city employees receive uniform basic health coverage for certain categories of drugs -- currently, injectables, chemotherapy drugs and asthma medications.

The mayor's office said that program costs $300 million annually, and does include some HIV/AIDS drugs. If PrEP were added, it would cost at least $144 million more annually, they said.

But Johnson said the Office of Labor Relations should negotiate with insurance providers to cover PrEP drugs -- including Truvada, the brand name of a drug that can be used both pre-exposure and as part of HIV/AIDS treatment -- and use its purchasing power in doing so.

"We have such power because of the number of people that are covered and how much money these health insurance companies are getting that it shouldn't be a big lift," Johnson said.

* Health Insurance

* HIV -- AIDS

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