HIV+Hepatitis Policy Institute

In violation of the ACA preventive services coverage requirement, Delta Air Lines, which has 100,000 employees in the United States, is only covering daily oral generic PrEP to prevent HIV without prior authorization.  Contrary to the ACA, it is refusing to cover the full array of PrEP drugs specifically required by the United States Preventative Services Task Force (“UPSTF”) without access restrictions in its employee health plan.

In recent months, the HIV+Hepatitis Policy Institute has reached out to Delta officials after employees received notice that Delta would no longer cover a branded oral PrEP drug. Delta’s Chief Health and Wellness Officer responded initially that the notices were “sent inadvertently” and Delta would “cover all three formulations of PrEP without cost-sharing subject to the terms and conditions of the plans.” However, since then, employees have received new notices that only generic PrEP would be covered without prior authorization. In response, we sent a second letter and this time Delta’s lawyers responded by simply arguing, without explanation, that they are in compliance with the ACA and its implementing regulations.

“We are extremely disappointed in Delta Air Lines, which has a substantial employee base who can benefit from PrEP, for failing to comply with the ACA’s preventive services requirements,” commented Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “The law, along with its implementing regulations, is very clear: health plans must cover all forms of PrEP recommended by the USPSTF without cost-sharing and not restrict access using prior authorizations to favor one form of PrEP recommended by the USPSTF over others. By only favoring generic PrEP, Delta is clearly violating the law.”

The current federal PrEP guidance to insurers specifically requires coverage of effective PrEP agents, including the once every two-months long-acting PrEP drug (Apretude) and another oral brand name PrEP drug (Descovy). It was issued prior to FDA approval of the newest form of long-acting PrEP (Yeztugo), but the recommendation speaks specifically to any “effective” PrEP medication.

Delta has said it will only cover the new twice-yearly PrEP drug after the USPSTF reviews it, notwithstanding the fact that the USPSTF has already issued a Grade “A” recommendation for any “effective” PrEP medication.   Not covering Yeztugo also violates a number of state laws.

“Delta has a large employee base in Atlanta, a city with one of the highest number of HIV cases in the country that primarily is impacting the Black community. As a corporate citizen, Delta has an obligation and duty to protect its employees against HIV,” said Dr. Daniel Driffin, an Atlanta public health activist. “Failing to cover long-acting PrEP and requiring people to jump through prior authorization hoops so they can protect themselves against HIV will lead to increased HIV. Delta, along with other employers, should be doing everything possible to prevent HIV.”

We are receiving reports from PrEP providers in Atlanta and elsewhere that Delta employees who were using PrEP are not taking their drugs and falling out of care. Due to the nature of their work and travel schedules, airline employees are perfect candidates for long-acting PrEP, but Delta is not offering it.

“We call on Delta to reassess their PrEP coverage, which not only impacts employees and their family members in Atlanta but throughout the country and across the globe,” added Schmid. He concluded, “We also call on the U.S Department of Labor to investigate this situation and enforce the regulations that it issued to ensure all employers, including Delta, are in compliance with the law.”