HIV Medicine Association and National Alliance of State and Territorial AIDS Directors Warn of Tens of Thousands of New HIV Cases and Billions in Health Care Costs if Decision in Braidwood v. Becerra is Allowed to Stand
The organizations, which represent thousands of healthcare providers, public officials, and policy experts with expertise in the treatment and prevention of HIV and the demographics and dynamics of the epidemic, filed a friend-of-the-court brief in the Fifth Circuit Court of Appeals
(BOSTON) June 28, 2023 – The HIV Medicine Association (HIVMA) and the National Alliance of State and Territorial AIDS Directors (NASTAD) have filed a friend-of-the-court brief at the U.S. Court of Appeals for the Fifth Circuit, urging reversal of the federal district court order in Braidwood v. Becerra. That ruling blocked a requirement under the Affordable Care Act (ACA) that insurers cover designated preventive care services, including HIV PrEP (Pre-Exposure Prophylaxis), without cost sharing. HIV PrEP is an extraordinary medical breakthrough that reduces the risk of HIV transmission by close to one hundred percent.
The brief was authored by attorneys at GLBTQ Legal Advocates & Defenders and the law firm Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C.
NASTAD and HIVMA include thousands of physicians and other healthcare providers with expertise in the treatment and prevention of HIV; government public officials from every state responsible for stopping the epidemic; and policy experts who understand the demographics and dynamics of the epidemic. Their brief lays out critical information demonstrating how requiring copays and deductibles for PrEP will significantly decrease utilization of PrEP, cause tens of thousands of new and preventable HIV cases, with billions of dollars in associated healthcare costs, and reverse the progress our nation has made towards curbing, and ultimately ending, the HIV epidemic.
“As an organization representing thousands of physicians and other health care professionals working on the frontlines of the HIV epidemic in communities across the country, we are deeply concerned about the harmful and far-reaching impacts this decision will have if allowed to stand,” said Michelle Cespedes, MD, MS, Chair, HIVMA. “Reinstating cost-sharing for PrEP would directly cause tens of thousands of preventable cases of HIV transmission and set back decades of progress toward curbing the epidemic.”
While the ruling from the Texas court in Braidwood v. Becerra broadly enjoined the cost-sharing mandate for all recommended preventive services, the case began as a challenge specifically to the requirement to cover PrEP without copays or deductibles. The brief filed today provides the Court of Appeals with important historical and current-day information about the tremendous toll the HIV epidemic has had on millions of lives, as well as the role discrimination and stigma have played in preventing Americans from accessing highly effective prevention and treatment.
“The Braidwood decision is rooted in stigma and bigotry towards the LGBTQ+ community and people vulnerable to HIV,” said Dr. Stephen Lee, NASTAD Executive Director. “It will cause incalculable harm to our efforts to end the HIV epidemic. We are pleased to join HIVMA in filing an amicus brief to help offer insight into why this decision is so detrimental to our HIV/AIDS public health system.”
The brief cites a recent epidemiological analysis conducted by experts at Harvard and Yale predicting, under the most cautious and conservative estimates, that blocking the ACA’s no cost sharing provision for PrEP will result in an additional 2,057 HIV infections in the first year alone. Including an additional predicted 1,892 secondary infections brings that number to 3,949 people with HIV in just the first year, which will cost the healthcare system a staggering $1.66 billion. Extending that conservative model just five years into the future predicts approximately an additional 20,000 people with HIV and costs to the United States healthcare system of over $8 billion as a result of the reimposition of barriers to accessing PrEP.
The brief also describes the sobering and unacceptable racial/ethnic and geographic disparities in both the impact of the epidemic and access to PrEP. In 2021, the CDC estimates that only 11% of Black people and 20% of Hispanic/Latino people who could benefit from PrEP were prescribed it, as opposed to 78% of White people. In the same year, more than half (52%) of new HIV infections were in the U.S. South, yet the states with the highest unmet need for PrEP are Alabama, Arkansas, South Carolina, and Mississippi.
“Copays and deductibles deter people from accessing healthcare,” said Ben Klein, Senior Director of Litigation and HIV Law at GLBTQ Legal Advocates & Defenders. “PrEP is nearly 100% effective at preventing transmission of HIV but it is already underutilized, particularly among Black and Latino communities. As the brief filed today by HIVMA and NASTAD demonstrates, allowing the lower court’s ruling in Braidwood v. Becerra to stand will exacerbate racial health disparities, increase new HIV diagnoses by the tens of thousands, and have devastating consequences on our efforts to end the epidemic. GLAD is pleased to partner with the HIVMA, NASTAD, and the law firm Mintz to ensure that the Court of Appeals understands the devastating consequences for HIV prevention if the District Court’s decision stands.”
“The brief filed today by HIVMA and NASTAD underscores the fact that tens of thousands of American lives and billions of dollars of healthcare costs are literally in the balance with the outcome of this case,” said Drew DeVoogd, Member, Mintz. “Mintz is happy to work with GLAD, HIVMA, and NASTAD to highlight the massive human harm and economic cost the District Court’s decision will have if it is allowed to stand, eroding many years of hard-won public health progress in the fight against the HIV epidemic.”
Through strategic litigation, public policy advocacy, and education, GLBTQ Legal Advocates & Defenders works in New England and nationally to create a just society free of discrimination based on gender identity and expression, HIV status, and sexual orientation. www.glad.org