After a tumultuous year of proposed program cuts and eliminations, Congress has agreed to reject them and instead has maintained funding for domestic HIV prevention and treatment programs on a bipartisan basis. Now, the Trump administration must focus its attention on properly implementing these programs in order to get the nation back on track to end HIV in the U.S.
“We are pleased that CVS Health has finally decided to cover this groundbreaking new PrEP medication. Four months ago, 63 HIV organizations joined us in sending a letter to CVS’s president urging them to reconsider their refusal to cover Yeztugo and reminding them of their legal obligation to cover PrEP and describe the important benefits the drug would bring to preventing HIV in the US. With this coverage decision, CVS joins other leading payers and PBMs in covering the new medication.”
We are pleased to see the improvements in Medica’s coverage of HIV drugs. While it took a year, with two letters and a great deal of research, we are grateful to the Iowa insurance department for working with Medica on these changes. Though we never received a formal response from the Minnesota insurance department, we assume our c omplaint played a major role in that state as well. Despite the substantial improvements in Medica’s formularies, the issuer still offers substandard coverage and remains an outlier when compared to other issuers on the Iowa and Minnesota Marketplaces, as we have detailed in follow-up letters to regulators in both states.
“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.”
We commend the CDC for issuing this recommendation of such a groundbreaking new PrEP option only three months after its approval. The entire world is excited about this PrEP drug that for the first time resulted in zero infections in clinical trials, and was hailed by Science magazine as the 2024 Breakthrough of the Year. Now we must make sure that everyone who wants it is able to access it. This includes people with health insurance who should be able to access it without cost or other barriers in accordance with federal and state coverage requirements. Unfortunately, we are already hearing of payer roadblocks. CVS Health’s pharmacy benefit manager has gone on record that it is not covering the drug, putting this transformative drug out of reach for many who need it. This is why 63 organizations joined us in a HIV community letter sent today to CVS Health President and CEO David Joyner that lays out their obligation to cover it and urges them to reverse this harmful decision immediately.