PrEP access has been maintained for most Americans after an appeals court ruling ended a lawsuit that challenged the medication’s coverage. 

In a ruling that upholds crucial components of the Affordable Care Act, the Fifth Circuit Court of Appeals ruled on Friday in Braidwood Management, Inc. v. Becerra, mandating that most insurance providers continue to cover preventive services, including PrEP medication, while deeming parts of the law unconstitutional.

The Advocatewas first to report in 2022 that the plaintiffs, led by Jonathan Mitchell, an ultraconservativeTexas lawyer with a history of challengingLGBTQ+ rights, argued that the ACA’s requirement for insurance plans to cover preventive services violated their religious freedom. They specifically objected to covering PrEP, pre-exposure prophylaxis, a medication that prevents HIV transmission, citing their Christian beliefs against homosexuality.

Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas, who has also been allergic to LGBTQ+ causes, initially sided with the plaintiffs, ruling that the ACA mandate infringed on their religious freedom. The Department of Justicequickly appealed to the Fifth Circuit Court of Appeals, which has jurisdiction over Texas,Louisiana, andMississippi.

In itsruling, the Fifth Circuit upheld the lower court’s decision but limited the scope of the exemption to the plaintiffs in the case. This means that the broader mandate requiring most insurance providers to cover preventive services, including PrEP, remains in effect for the rest of the nation. 

The court also addressed constitutional issues regarding the appointments of the United States Preventive Services Task Force members. It determined that these members are principal officers under Article II of the Constitution and must be appointed by the president and confirmed by the Senate. While this raised constitutional concerns, the court reversed the district court’s decision to vacate all agency actions enforcing the preventive care mandates, deeming the remedy overly broad.

Lambda Legal, an advocacy group for LGBTQ+ rights, responded to the decision with cautious relief. “Lambda Legal is relieved after the recent narrow decision by the U.S. Court of Appeals for the Fifth Circuit in the case of Braidwood v. Becerra that ruled most of the nation’s insurance providers must continue to cover PrEP medication and other preventative services,” said Jose Abrigo, Lambda Legal’s HIV project director.

Abrigo pointed out that the ruling’s limitation to the plaintiffs ensures broader protections and national healthcare policies remain intact. However, he expressed concerns about the potential for future legal challenges that could threaten healthcare rights and protections for millions of Americans.

He emphasized the importance of preventative care, noting that PrEP plays a critical role in the fight against HIV and AIDS. Access to such preventive measures is crucial for reducing preventable diseases and promoting public health. “Lambda Legal will closely monitor any further developments related to this case and similar legal challenges,” Abrigo said.

The case will likely go to the Supreme Court when either side appeals the ruling.