Mary Elizabeth Marr sees trouble coming.
She’s the CEO of Thrive Alabama in Huntsville, a federally qualified health center (FQHC) that serves about 8,000 patients—1,000 of them living with HIV and many more of them belonging to key HIV risk groups: gay men (especially Black gay men), transgender women, and Black cisgender women.
In recent years, Thrive has prescribed PrEP (the HIV-preventing combo pills Truvada or Descovy—or, now, Truvada’s generic twins) for hundreds of those at-risk patients. Because Alabama is one of 12 states that has not, under an option in the Affordable Care Act, expanded Medicaid beyond the very poor to the moderately poor, many Thrive patients on PrEP are covered by a charity program run by Gilead, the multibillion-dollar-profiting maker of Truvada and Descovy.
The charity program not only allows health centers to give such patients the drug for…