ACA

71 patient groups comment on how nondiscrimination in healthcare rule can improve prescription drug access

The HIV+Hepatitis Policy Institute (HIV+Hep) and the Autoimmune Association, along with 69 other patient organizations, commented on how the Section 1557 nondiscrimination in healthcare proposed rule can be used to improve patient access to prescription drugs. In their comment letter, the patient groups expressed strong support for the “meaningful steps to improve upon current regulations to ensure that people are not discriminated against in healthcare. In several instances, you have proposed to restore protections that had been included in the past but later withdrawn. In other instances, you have provided further clarity on what constitutes discrimination. In any instance, we emphasize that the law and whatever is finalized in regulation must be strictly enforced.”

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Patient groups file suit to end policy that prohibits copay assistance from counting toward patients’ out-of-pocket spending

The HIV+Hepatitis Policy Insite, the Diabetes Leadership Council, and the Diabetes Patient Advocacy Coalition filed suit in the U.S. District Court for the District of Columbia challenging a federal rule that allows health insurers and pharmacy benefits managers to avoid counting drug manufacturer copay assistance toward patients’ out-of-pocket cost obligations. Due to increased deductibles and cost-sharing requirements, patients rely on copay assistance to help them afford their #Rx.

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Insurers warned that excessive utilization management of prescription drugs is potentially discriminatory

s part of the Biden administration’s proposed rule to implement the Affordable Care Act’s nondiscrimination provisions, excessive use of utilization management for prescription drugs, including prior authorization, step therapy, and durational or quantity limits could be deemed discriminatory. Additionally, the proposed rule adds back protections that prohibit insurers and other health programs from engaging in marketing practices and benefit design that discriminate on the basis of certain conditions, including disability. 

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Federal Government Issues Guidance to Insurers on Coverage of HIV Prevention Drugs

Today, the federal government issued guidance to insurers to remind them of their obligation to cover pre-exposure prophylaxis (PrEP), which are drugs that prevent HIV, at no cost to their beneficiaries. The guidance, in the form of an FAQ, also clarifies that associated services with PrEP, such as provider visits and HIV, hepatitis, and STD testing along with other laboratory tests, must also be covered with no patient cost-sharing. This follows previous guidance for the coverage of other preventive services that have associated services and costs, such as colonoscopies.

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