The grocery store chain, Publix, has a history of refusing to provide its employees coverage for PrEP, a daily pill strategy that prevents a user from contracting HIV. Poz blogger Josh Robbins first reported of such discrimination in November 2016.
— Josh Robbins (@imstilljosh) November 2, 2016
Now, reports of another employee being denied coverage for PrEP is putting the company's moral authority into question.
According to its website, the Florida-based Publix has 1,168 stores and employs nearly 188,000 people across seven states in the southern United States — largely in Florida and Georgia, which also happen to be the states most impacted by HIV, according to the Centers for Disease Control and Prevention.
David Holland, assistant professor of medicine at Emory University and director of the Fulton County PrEP clinic in Atlanta, tried to get PrEP coverage for a Publix employee, but was denied. "We've started over 400 people on PrEP at our clinic alone, and this is the only person that we weren't able to get PrEP for," Holland said to TheBody.com. The employee later appealed the denial twice, and was denied both times.
According to Holland, this case was the only one his team wasn't able to resolve through an appeal. "What we found out from the insurance company was that it came, ultimately, from the employer," he added. "It wasn't just an insurance issue; it was [that] the employer did not want it covered in the insurance."
The benefits of PrEP is widely documented. For example, clinics in London saw a near 40 percent drop in new HIV diagnoses last year, compared to 2015. According to NewScientist.com, the decline was likely due to thousands of people who started practicing PrEP.
“We need to be very cautious at this stage, but I can’t see what else it can be,” Will Nutland at the London School of Hygiene and Tropical Medicine, said at the time. “Something extraordinary has happened in the last 12 months because of a bunch of DIY activists working off our kitchen tables.”
According to Gilead Sciences, the manufacturer of Truvada, the only PrEP drug approved by the U.S. Food and Drug Administration, 125,000 U.S. residents were practicing PrEP as of early 2017.
"Annually, we evaluate benefits covered under our health plans," Publix spokesperson Brenda Reid wrote in a statement when asked about the lack of coverage for PrEP. "There are numerous medications covered by the plan used in the treatment of HIV." She added, “There are some medications that have coverage limitations or require prior authorization. Any Publix associate with questions regarding his or her coverage can contact our benefits department directly."
As noted by Think Progress, Publix one of the only companies in the Fortune 1000 that refuses to participate in the Human Rights Campaign’s Corporate Equality Index, an index that scores businesses on how they treat their LGBT employees and customers. In 2013, the company received a zero rating for LGBT friendliness.
Publix’s conservative values has undoubtedly created internal discrimination within the company. In 2012, Broward County’s Human Rights Board demanded Publix to pay a gay cake decorator $100,000 after he claimed he was fired because he was gay (the decision was later overturned). Additionally, other gay employees told Miami’s New Times they were denied benefits such as bereavement pay when their partners died.
"I think it's still 1965 in their eyes," David Cary Hart, a retired CEO of Drake Business School and an LGBT activist, told New Times. “They have absolutely no sensitivity to this issue whatsoever."
As New Times reports, “In 2000, the company paid $10.5 million to settle a class-action lawsuit alleging racial discrimination against its employees. Just three years earlier, Publix paid out $81.5 million to 150,000 women who accused the chain of giving them dead-end, low-paying jobs.”
Several advocates say this case parallels the U.S. Supreme Court’s 2014 decision in Burwell v. Hobby Lobby Stores, Inc., which ruled that privately held companies can be exempted from the Affordable Care Act’s mandate to provide contraception based on their owners’s religious views.
Imposing moral authority seems to make sense, according to Think Progress, which points out that PrEP coverage would cost Publix far less than to provide antiretrovirals to someone who contracted HIV.
"The idea [is] that health coverage is voluntary, is an additive benefit and that it is [provided] by the good grace of employers," Anne Tucker, associate professor at the Georgia State University College of Law, said to TheBody.com. "[It] is not considered a baseline right. That's the default setting; that's the frame of reference most people have."