The HIV+Hepatitis Policy Institute is asking insurance regulators in West Virginia, Pennsylvania, and Delaware to investigate Highmark Blue Cross Blue Shield for what we believe is an effort to profit by diverting copay assistance from drug manufacturers meant to assist patients and splitting the funds between itself a third-party vendor.
In the 2027 Notice of Benefit and Payment Parameters rule proposed today, the administration failed to include promised new regulations on whether copay assistance will count towards patient cost-sharing. “Every day this rule is delayed is another day that insurers and PBMs are pocketing billions of dollars meant for patients who are struggling to afford their drugs,” commented Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “We know that President Trump is squarely focused on drug affordability, and while we are extremely disappointed that this simple step was not yet taken, we urge the administration to act in the very near future.”
“We are extremely disappointed in Delta Air Lines, which has a substantial employee base who can benefit from PrEP, for failing to comply with the ACA’s preventive services requirements,” commented Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “The law, along with its implementing regulations, is very clear: health plans must cover all forms of PrEP recommended by the USPSTF without cost-sharing and not restrict access using prior authorizations to favor one form of PrEP recommended by the USPSTF over others. By only favoring generic PrEP, Delta is clearly violating the law.”
“While we strongly support the legislation that requires payers to cover PrEP for people who have insurance, ensuring sufficient and stable funding for the CDC so that health departments, community-based organizations and other grantees can implement HIV and hepatitis prevention programs nationwide is also vitally important,” said Carl Schmid, Executive Director of the HIV+Hepatitis Policy Institute. “We commend Congresswoman Waters and her colleagues for introducing these bills and urge the Congress to support them so that we can eventually end HIV and hepatitis in the United States.”
CVS Health’s decision is a clear violation of the ACA’s requirement to cover USPSTF-recommended preventive services, including PrEP. The entire world is excited by this drug and its potential contribution to preventing and eventually ending HIV. However, a drug will only work if people can access it and right now CVS Health, which owns the largest pharmacy benefit manager in the country, is shamefully blocking people from taking it, unlike other payers. We urge CVS, which has been committed to ending HIV in the past, to reconsider their decision immediately. Additionally, we call on federal and state regulators to ensure that plans are in compliance with the federal government’s PrEP coverage guidance and the many state laws that require coverage of all PrEP drugs.