Supermarket chain Publix announced Tuesday it will include HIV prevention method PrEP in its employee healthcare plans, changing policy a day after meeting with Florida Rep. Carlos Guillermo Smith, the Legislature’s first openly gay Latino member.
A trio of Tuesday morning Tweets off Publix’s corporate account read, “Publix appreciates the concerns shared by our associates and customers. We offer generous health coverage to our eligible full-time and part-time associates at an affordable premium and are committed to the health and well-being of our associates and their families....We regularly evaluate what is covered by our health plan and have made the decision to expand our health plan’s coverage of Truvada to include Pre-exposure Prophylaxis (PrEP). We are working with our pharmacy benefits manager to implement this change as quickly as possible.”
The Florida Department of Health’s website explains PrEP as “a comprehensive HIV prevention strategy that involves the daily use of antiretroviral medications to reduce the risk of HIV infection in HIV-negative individuals.” The Centers for Disease Control lauds PrEP as 92-percent effective at preventing infection among high-risk users who take the drug daily.
Publix said it employs 12,965 full or part-time employees in Miami-Dade, 14,086 in Broward County and 136,708 throughout Florida.
The significance in the direction shift by one of Florida’s largest employers can be demonstrated by looking at two maps: Publix’s stores and the Centers for Disease Control’s map of new HIV infection rates in 2016. According to the CDC, Florida’s 28 new HIV cases per 100,000 people in 2016 was the fourth most in the United States, behind the District of Columbia (55.6), Georgia (31.8) and Louisiana (29.7). The states where the seven-state chain has the most stores: Florida and Georgia.
“It is a positive step forward that an employer as large as Publix will now offer PrEP to its employees as part of their healthcare coverage,” said a statement by Mary Beth Maxwell, Senior Vice President for Programs, Research and Training at the Human Rights Campaign. “Publix has locations predominantly in the South, where HIV disproportionately affects the population, making this decision all the more impactful and necessary. We hope this decision by Publix will inspire other large employers to think seriously about ensuring that their health plans address all employees’ needs.”
Over the last few weeks, HRC and other groups expressed displeasure with Publix over refusing to cover PrEP. For the uninsured, a prescription for PrEP pill Truvada, which is also used to treat HIV, can cost about $13,000 a year, although that price can be lowered through payment assistance offered by the drug manufacturer. While Publix already provided coverage for Truvada, that covered the treatment of HIV — not its prevention.
“Coverage is not generally provided to diagnose a medical condition for which a member has no indications or to treat a medical condition that a member might get in the future,” the company said on Twitter last week.
Smith, who was elected in 2016 and represents Orlando, met with Publix’s government relations team Monday, taking up the issue after reading news reports of the policy.
“I wanted to hear it from them directly, it wasn’t really confirmed,” he said. “Unfortunately, yes, they confirmed that Publix is absolutely denying PrEP.”
He said the Publix team made clear the company itself, not any insurers, had decided to deny PrEP coverage, but wouldn’t say if the roots of that decision sat in cost or a moral objection.
Publix noted an absence of formal recommendation of PrEP coverage by the U.S. Preventive Services Task Force, although the CDC recommends it and the Task Force is currently reviewing the issue, Smith said. And despite its statement that the company doesn’t cover preventive care, Smith said they do cover birth control.
While denying coverage of PrEP is not illegal, Smith said Publix’s old policy left it vulnerable to privacy lawsuits. Under the policy, he said, employees would have to petition the company describing why the coverage was necessary.
“The reason why is none of Publix’s damn business,” he added. “It’s no one’s business except for that person, their partner and their doctor.”
Following the meeting, he said the company — which employs nearly a quarter million people — was “actively re-evaluating” its stance.
Less than 24 hours later, the policy changed.
Smith, accustomed to the slow-moving grind of Tallahassee, was surprised with the sudden reversal, heralding the announcement as a “huge victory” for the LGBTQ community. After Monday’s meeting, Smith turned to social media to gauge the interest from his followers. The reaction was overwhelming, he said.
“Speaking out actually pays dividends,” he said.