The Biden-Harris administration has a historic opportunity to help end HIV. New, cutting-edge drugs that prevent HIV are hitting the market, but insurance companies are trying to twist the rules to deny access to these remarkable therapies. The White House could stop these abuses and put the country on the right course for decades ahead and prevent hundreds of thousands of new HIV transmissions.
If the administration does not act, patients nationwide will continue to be subject to schemes that lead to higher out-of-pocket costs for the medications they need, risking medical debt or facing treatment delays and lack of adherence. To protect patients, essential health benefits drugs must be rightfully treated with the gravity that their name implies—medications that are “essential” to a healthy life for patients.
For years, greedy insurers and PBMs, who have been in the news lately, have used copay accumulators and other nefarious tactics to inflate patient costs and increase their profits. It’s time for President Biden, Vice President Harris, and Secretary Becerra to do something about it.
Among Americans who take prescription drugs, a quarter struggle to afford their medication. For those who are in poor health or have low incomes, the portion is even higher. These days, the rising cost of everyday goods and services is forcing more people to face difficult decisions and ask themselves: How can I pay for utilities, the groceries, or the medicine that’s keeping me alive? Now imagine that someone offers you financial assistance for the express purpose of paying for your medicine—problem apparently solved. But in a cruel twist, your health insurer pockets that assistance, without counting it toward your annual deductible or out-of-pocket maximum. That’s why the HIV+Hepatitis Policy Institute, the Diabetes Leadership Council, and the Diabetes Patient Advocacy Coalition filed suit in federal court, challenging the Trump-era federal government rule that allows insurers and pharmacy benefit managers to carry out this harmful practice.
Falling ill in America is becoming increasingly unaffordable in a health care system that punishes the patient. Insurance companies and middlemen have taken away protections against health care discrimination and crushing out of pocket costs for people with complex and chronic conditions. Not only does this increase costs across the health care system, it also deters efforts to improve health equity and patient outcomes.