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.”
Today marks a monumental step in transforming drug pricing and making prescription drugs more affordable for the American people, particularly for those without insurance. For those who do have insurance, TrumpRx may not always be the best option. We hope consumers clearly understand this and urge the Trump administration to expand the site and work with insurers so that TrumpRx payments are counted by insurers. Frankly, if people who have health insurance are using TrumpRx, it demonstrates that the insurer is failing to meet the needs of its paying consumers.
Thanks to the leadership of Councilmembers Zachary Parker and Christina Henderson, DC residents who are at risk of HIV will be able to access all forms of PrEP without cost-sharing or prior authorization. This is particularly important since federal preventive health requirements have recently come under attack. We are especially grateful for the amendment to the bill that will require insurers to cover all PrEP drugs, including new long-acting regimens.
“Patients with HIV, hepatitis, and so many other health conditions rely on copay assistance to afford their drugs. Healthcare is already expensive and when insurers add additional barriers and costs, such as not counting copay assistance towards a patient’s deductible, patients’ costs significantly increase, jeopardizing medication adherence and their health,” said Carl Schmid, Executive Director, HIV+Hepatitis Policy Institute. “We applaud Governor Murphy for signing this bipartisan legislation to put an end to hidden insurer practices that drive up patient costs.”