Student plan limits coverage for HIV drug

Ellen Schmidt

As the population of young people affected by HIV rises at the state level, a preventative drug called Truvada is prescribed increasingly to keep the partners of those infected safe.
 
The University of Minnesota’s Student Health Benefit Plan doesn’t cover the drug for undergraduate students in need, in contrast to the faculty and graduate teaching assistant plans.
 
Truvada is prescribed to people at high risk for getting HIV — like those with HIV-positive partners — and reduces the risk of contracting the virus by up to 92 percent when taken consistently, according to the Centers for Disease Control and Prevention.
 
The Minnesota Department of Health’s latest statistics show 13- to 29-year-olds get the least care in the state for HIV, often because they often don’t have access to a doctor. Of those ages, 20- to 29-year-olds make up most of the infections in the state.
 
A majority of the health insurance plans in Minnesota cover Truvada, including public plans like MinnesotaCare, said Dr. Keith Henry, the research director for Hennepin County Medical Center’s HIV/AIDS program.
 
The Affordable Care Act requires some insurance programs to cover Truvada and other preventative medications, said Sue Jackson, director of the Office of Student Health Benefits, but because the University finances its own student plan, it has no such requirement.
 
The school’s undergraduate student plan chose not to cover Truvada in an effort to keep the cost of the plan down, Jackson said.
 
“If we cover any percentage of those expensive drugs — chemotherapy or any of those drugs — then the plan couldn’t carry the cost [and] we would not be able to get any drug assistance program benefits for our students,” she said.
 
Drug assistance programs, like one offered through Gilead Sciences, Inc. — Truvada’s manufacturer — provide low-income and uninsured patients the drug at no cost, giving the company a tax write-off. 
 
Jackson said the University refers all Truvada-seeking students to drug assistance programs. Law student Thomas Hale-Kupiec said he had to hunt down a program alone.
 
Hale-Kupiec has an HIV-positive partner, making him at higher risk for HIV transmission. After moving from Washington, D.C., to Minneapolis for school, Hale-Kupiec
took advantage of the student health benefit plan to continue receiving coverage for his Truvada prescription — only he found out later he wasn’t covered.
 
During a call with the Office of Student Health Benefits, Hale-Kupiec was told that the drug could be covered although he was a student but not a faculty member or graduate teaching assistant. But when he went to Boynton Health Service to refill his prescription, he found out he’d need to pay the full cost of Truvada, which was upwards of $1,000, Hale-Kupiec said.
 
“I had done everything in my power to understand the plan and to know what my rights were. However, I couldn’t navigate the system,” Hale-Kupiec said.
 
In response, he appealed the decision and received a formal letter of denial from the Office of Student Health Benefits, which gave him the opportunity to seek out other providers.
 
Red Door Services, a public health clinic run by the Hennepin County Medical Center, accommodated his need for Truvada.
 
But drug assistance programs and public health clinics like Red Door Services are overwhelmed, resulting in long wait times for patients in need of sexual health care, Hale-Kupiec said.
 
“Not all individuals should be on [Truvada]. That’s between them and their doctor,” he said. “But it shouldn’t be an access point that the ‘U’ is controlling.”
 
Hale-Kupiec’s partner, Andy Kleinendorst, works as a health care consultant for HealthPartners, an insurance provider in Minnesota. Through his job, Kleinendorst learned Hale-Kupiec would have been without medication for the month-long insurance appeal process had he followed the steps recommended by the University.
 
“It was unsettling to know how many barriers [Hale-Kupiec] was going through,” Kleinendorst said.  “It doesn’t have to be that hard when you’re trying to take agency of your sex life with the resources available.”
 
Some oppose the use of Truvada, however, claiming it excuses irresponsible sexual behavior or use of unsterile needles, all while getting protection from HIV transmission, Dr. Keith Henry said.
 
The year-long process of obtaining Truvada dismisses that theory, he said.
 
Patients receiving Truvada from Red Door Services are required to visit their doctors four times per year during their first year of treatment. Between their visits,
patients are tested for STDs and receive counseling. When patients come in regularly, studies show they practice safer sex, Henry said.
 
“The health care system needs to get its act together to make health care more user-friendly for people with a wide range of backgrounds and personality types,” Henry said.