An upcoming Supreme Court case could make PrEP less affordable—does it have to?

BY Shalene Gupta. Originally published in Fast Company on February 24, 2025.

Elizabeth Kaplan is quoted in this article.

One of the most effective factors in containing the spread of HIV has been the widespread availability of preexposure prophylaxis (PrEP). A PrEP regimen—which has grown to include daily pills or injections every few months—can decrease the chances of HIV infection by up to 99%. To build on those gains, in 2021, the federal government, under the Affordable Care Act, mandated that health insurers fully cover PrEP, as well as clinical visits and the labs required every three months.

But an upcoming hearing before the Supreme Court could upend that mandate. The case—brought by six individuals and two companies—is focused on whether mandating coverage of PrEP violates the religious freedom of certain business owners. Braidwood Management, one of the companies, is arguing PrEP coverage “facilitates and encourages homosexual behavior, intravenous drug use, and sexual activity outside of marriage between one man and one woman,” according to the organization’s petition to the Supreme Court.

“HIV doesn’t just impact the LGBTQ community,” says Kate Steinle, chief clinical cfficer at Folx Health, a healthcare provider focused on the queer community. “Removing this coverage [would] affect so many people.”

There are currently 1.2 million people in the United States with HIV. While HIV infection rates have decreased over 75% since the mid-1980s, in 2022 there were at over 31,000 new cases of HIV infection in the US. About 20% of the new cases are women, 83% of whom were infected during sex with men.

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