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A Federal Judge in Texas Finds PrEP Coverage Mandate Violates Religious Freedom

Emily Turner

SAN ANSELMO, CA - NOVEMBER 23:  Antiretroviral pills Truvada sit on a tray at Jack's Pharmacy on November 23, 2010 in San Anselmo, California. A study published by the New England Journal of Medicine showed that men who took the daily antiretroviral pill Truvada significantly reduced their risk of contracting HIV.  (Photo Illustration by Justin Sullivan/Getty Images)

A federal judge in Texas delivered a blow to the affordability and accessibility of the HIV prevention drug PrEP in the state. On Sept. 7, Judge Reed O’Connor of the Northern District released his opinion deeming employers not responsible for providing coverage of the drug, clinically named pre-exposure prophylaxis. PrEP is a key preventative service protected under the Affordable Care Act, but O’Connor found that the provision of the ACA mandating that employers provide free coverage of PrEP with no cost sharing to be in violation of their religious freedom.

The complaint was first filed in 2020 as Kelley v. Becerra before being renamed Braidwood Management v. Becerra, allegedly due in part to the negative attention the case initially received, reports the Advocate. The plaintiffs expressed disapproval of not only the drug mandate but also the drug itself. The document stated one plaintiff “is also a Christian, and he is therefore unwilling to purchase health insurance that subsidizes abortifacient contraception or PrEP drugs that encourage homosexual behavior or intravenous drug use.”

O’Connor, who was nominated by former president George W. Bush in 2007, sided with the plaintiffs, finding the mandate to be in violation of the Religious Freedom Restoration Act. The judge also claimed the government’s Preventive Services Task Force did not successfully argue why employers are required to subsidize PrEP, despite the drug costing individuals up to $2,000 a month without adequate insurance coverage. “Defendants outline a generalized policy to combat the spread of HIV, but they provide no evidence connecting that policy to employers,” O’Connor said, “nor do they provide evidence distinguishing potential religious exemptions from existing secular exemptions.”

GLAAD responded to news of the ruling on Twitter, writing, “Preventing HIV is a public health imperative and should be a priority for all companies. Efforts to deny coverage pose a threat to public health and safety.”

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