“While we are pleased that CMS is taking steps to clamp down on insurers who are abusing the system by covering drugs without including them as part of essential health benefits, we are disappointed they are not directing payers to immediately count copay assistance, at a minimum, for brand name drugs without a generic alternative,” commented Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “While we understand that the case was recently decided, it will be important that CMS issue guidance that directs payers to comply now with the Court’s decision and ensure enforcement.”
From the office of Massachusetts Senate President Karen E. Spilka: Senate passes bill expanding access to HIV prevention drug
“For the first time since PrEP became available eleven years ago, over a third of the people CDC believes could benefit from being on PrEP are being prescribed it. However, there are stark and widening racial, ethnic, and gender disparities in PrEP use in Massachusetts and nationwide,” said Kevin Herwig, Health Policy Manager at HIV+Hepatitis Policy Institute. “Allowing pharmacists to prescribe PrEP, as well as to link people with PrEP clinical services and HIV testing, will help remove barriers to getting HIV preventive medication for people and communities who have not yet been able to benefit from the promise of PrEP. We thank the Senate, Senate President Spilka, Senator Cyr, and others for supporting this important legislation.”
In a major victory for patients who depend on prescription drugs, Judge John D. Bates of the U.S. District Court for the District of Columbia struck down a Trump administration federal rule that allowed health insurers to not count drug manufacturer copay assistance towards a beneficiary’s out-of-pocket costs. The case was brought against the U.S. Department of Health and Human Services by the HIV+Hepatitis Policy Institute, Diabetes Leadership Council, Diabetes Patient Advocacy Coalition, and three patients who depend on copay assistance and whose insurers implemented “copay accumulator” policies.
Today, the HIV+Hepatitis Policy Institute filed another complaint against an insurer for violating the patient protections included in the Affordable Care Act. This time, the group alleges that Community Health Choice Texas, based in Houston, offers substandard HIV drug coverage by not covering recommended drugs for HIV treatment, including single tablet regimens, and is discriminating against people with HIV by placing most of the drugs that it does cover on the highest and most costly tier.
Months after the HIV+Hepatitis Policy Institute and the North Carolina AIDS Action Network filed discrimination complaints against Blue Cross and Blue Shield of North Carolina for placing almost all HIV drugs on the highest drug tiers, the insurer has released a new mid-year drug formulary that leaves not a single HIV drug on the highest and most costly drug tiers. Instead of 48 HIV drugs, including many generics, on Tiers 5 and 6, there are now none. As a result, depending on the plan, patients will be paying more reasonable and affordable costs.