A federal judge ruled Wednesday that required coverage of an HIV prevention drug under the Affordable Care Act violates a Texas employer’s religious beliefs and undercut the broader system that determines which preventive drugs are covered in the U.S.

The ruling was handed down by Fort Worth-based U.S. District Judge Reed O’Connor, who ruled in 2018 that the entire ACA is invalid. The U.S. Supreme Court ultimately overturned that decision.

O’Connor’s latest ruling targets a mandate under the law that requires employers to cover the HIV prevention treatment known as PrEP, which is a pill taken daily to prevent infection.

The challenge was brought by a company owned by Steven Hotze, a conservative activist in Texas who is described in the lawsuit as operating Braidwood Management “according to Christian principles and teaching.” It was filed by an architect of the Texas abortion law that was the nation’s strictest before the Supreme Court overturned Roe v. Wade earlier in June.

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The impact of the ruling beyond the plaintiffs was not immediately clear. But opponents condemned the decision as a threat to patients far beyond Texas.

“Defendants do not show a compelling interest in forcing private, religious corporations to cover PrEP drugs with no cost-sharing and no religious exemptions,” O’Connor wrote in his ruling.

He also ruled that a federal task force that recommends coverage of preventive treatments, which is made up of volunteer members, violates the appointment clause of the U.S. Constitution.

The Biden administration is likely to appeal. The U.S. Department of Health and Human Services did not immediately respond a requests for comment.

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