In August, United Healthcare was heavily criticized for denying coverage of Truvada to a bisexual client because, the company claimed, he engaged in “high risk homosexual behavior.” In addition to apologizing for the "insensitive language," United Healthcare announced that it was updating its policy and would no longer require pre-authorization for Truvada.

But now the company, one of the largest healthcare providers in the nation, seems to have created a new, subtler barrier to accessing the drug.

Currently Truvada is the only FDA-approved form of pre-exposure prophylaxis. It's highly effective—when used correctly, it's 92%–99% successful in preventing transmission of HIV—but it's also expensive. Many patients rely on secondary insurance—often in the form of "copay cards" or coupons provided by Truvada's manufacturer, Gilead—to help pay for it. For those with high-deductible plans through United Healthcare, prescription payments made with copay cards have always gone toward a patients' out-of-pocket maximum.

But that's about to change.

On the PrEP Facts Facebook group, David Cash, a gay man living in Connecticut, shared a copy of a letter he recently received from UHC.

The correspondence, dated December 1, states that when it comes to prescription medications, "only the amount you pay out of your own pocket will apply toward your deductible and out-of-pocket maximum" as of January 1, 2018. While the letter doesn't reference PrEP specifically, it's the only prescription he's on with a copay assistance plan.

"This is contrary to years of precedence with other medications," wrote Cash, who has been taking Truvada for two years. "This will end up costing people with high-deductible plans $3,600 more per year. Talk about a disincentive to use Truvada."

As a retiree on a limited income, he can't afford to stay on PrEP with that change in effect.

"I think it's a shameful thing they're doing," he tells NewNowNext. "They're just trying to reduce the utilization of PrEP because of its cost to them, which is pretty morally bankrupt, considering what it’s for."

UHC has previously claimed Truvada is one of the most expensive drugs it covers. While this change may be viewed internally as a cost-saving measure, HIV activist Damon L. Jacobs says it's counterproductive in the long run.

"It's illogical and irresponsible for UHC to add this extra barrier to PrEP access," Jacobs tells NewNowNext. "The CDC has acknowledged the role of PrEP in decreasing new HIV diagnoses. Providing obstacles to PrEP will result in more HIV transmissions, which will ultimately be of greater cost to United Healthcare."

He adds that, judging from the company's remarks against 'high-risk homosexual behavior,' "there seems to be a deeper level of contempt and disregard for the health of gay and bisexual men."

Commenters on Cash's Facebook post report other insurers in different states have sent out similar noticed about changes for 2018. United Healthcare did not respond to a request for comment before the time of publication.