Insurers

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Delta failing their employees by restricting access to PrEP drugs

Nov 10, 2025

“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.”

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Two years after Court victory, patients still saddled with unaffordable drug costs

Sep 22, 2025

Despite a major court victory nearing two years ago for patients’ ability to afford prescription drugs, the federal government has still not enforced the ruling by requiring insurers to count copay assistance towards patient cost-sharing. Although the Court gave the government the alternative to issue a new clarifying rule relating to drug manufacturer copay assistance and patient cost-sharing, no rule has been proposed two years after the government pledged to the Court and the public that it would.

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CDC Strongly Recommends New Long-Acting PrEP Drug

Sep 18, 2025

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.

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CVS health refusing to cover new long-acting PrEP drug

Aug 21, 2025

CVS Health’s decision is a clear violation of the ACA’s requirement to cover USPSTF-recommended preventive services, including PrEP. The entire world is excited by this drug and its potential contribution to preventing and eventually ending HIV. However, a drug will only work if people can access it and right now CVS Health, which owns the largest pharmacy benefit manager in the country, is shamefully blocking people from taking it, unlike other payers. We urge CVS, which has been committed to ending HIV in the past, to reconsider their decision immediately. Additionally, we call on federal and state regulators to ensure that plans are in compliance with the federal government’s PrEP coverage guidance and the many state laws that require coverage of all PrEP drugs.

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Eighty Advocacy Organizations Urge Labor Secretary to Close Harmful EHB Loophole

Apr 22, 2025

The HIV+Hepatitis Policy Institute, along with more than 75 organizations representing patients, providers, and public health advocates, is urging U.S. Secretary of Labor Lori Chavez-DeRemer to issue a promised federal rule that would close a harmful loophole that allows insurers, pharmacy benefit managers (PBMs), and third-party vendors to exploit patient copay assistance programs for financial gain. In a letter sent today, the groups call on the Department of Labor (DOL) to address a gap in the enforcement of the Essential Health Benefits (EHB) provision of federal law—one that enables insurers, PBMs, and third-party vendors to designate certain covered drugs as “non-essential,” evading cost-sharing protections for patients.

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