Today, the HIV+Hepatitis Policy Institute (HIV+Hep) and the Autoimmune Association, along with 103 other organizations representing a broad range of patients across the country, submitted comments to the Federal Trade Commission (FTC) in response to a Request for Information (RFI) on the impact of pharmacy benefit manager (PBM) practices and the ability of patients to access and afford their prescription medications.
Biden administration begins to address patient affordability of medications: but fails to ensure copay assistance counts as patient cost-sharing
The Biden administration released a proposed rule that will govern how private health plans must operate in 2023 and in doing so, took some steps to limit patient cost-sharing for prescription drugs. However, despite the urging from patient groups, they are not requiring insurers and pharmacy benefit managers (PBMs) to count copay assistance towards patient out-of-pocket cost-sharing and deductibles.
The “Help Ensure Lower Patient Copays Act” would ban a cruel practice implemented by insurance companies that accept a patient’s copay assistance but does not apply it to the patient’s deductible and out-of-pocket cost obligations. This leaves the patient with potentially thousands of dollars in unanticipated costs.
The HIV+Hepatitis Policy Institute (HIV+Hep) and American Autoimmune Related Diseases Association (AARDA), along with 38 other patient organizations, filed comments earlier this week with the U.S. Department of Health and Human Services (HHS) addressed to Secretary Xavier Becerra that urge HHS to improve the affordability of prescription drugs for patients in the private insurance market through Standard Benefit Plans.
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.