Yesterday, 29 patient, provider, and consumer organizations representing a wide range of illnesses and health conditions filed an amicus brief in support of a case brought against the U.S. Department of Health and Human Services by the HIV+Hepatitis Policy Institute, the Diabetes Leadership Council, the Diabetes Patient Advocacy Coalition, and three patients. Filed in the U.S. District Court for the District of Columbia, the lawsuit challenges the federal 2021 Notice of Benefit and Payment Parameters rule, which allows health insurers to avoid counting the value of drug manufacturer copay assistance toward patients’ out-of-pocket cost obligations. Plaintiffs recently filed a motion for summary judgment, asserting that the rule violates cost-sharing requirements mandated by the Affordable Care Act and is also arbitrary and capricious.
HIV organizations file discrimination complaints against North Carolina Blue Cross Blue Shield
Today, 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, including generic Pre-Exposure Prophylaxis (PrEP), on the highest drug tiers, thus forcing people living with and vulnerable to HIV to pay excessive high costs to take their drugs.
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 In several instances, you have proposed to restore protections that had been included in the past but later withdrawn.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.”
Insurers warned that excessive utilization management of prescription drugs is potentially discriminatory
As 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.
Biden administration takes big step in making drugs affordable for patients: Also strengthens nondiscrimination protections
In reaction to the Biden administration’s announcement today that insurers on the federal exchange must offer standard plans, which for the most part use reasonable copay limits for prescription drugs, Carl Schmid, executive director, HIV+Hepatitis Policy Institute (HIV+Hep), issued the following statement: “This is a huge win for patients. Insurers have made it almost impossible for patients to afford their medications by first requiring them to meet a high deductible and then charging high co-insurance, which is a percentage of the list price of the drug. By limiting patient copays and keeping more drugs outside of the deductible, patients will be better able to afford their medications. We only wish the Biden administration would have applied these principles to more metal levels and drug tiers, but this provides better options for people who rely on prescription drugs.”