For years patients have seen manufacturer assistance diverted away from their deductibles and out‑of‑pocket maximums, increasing their costs and forcing impossible choices. We thank the subcommittee for urging CMS to act and call on the agency to promptly issue clear, enforceable guidance so patients actually receive the benefit of assistance meant for them.
The HIV+Hepatitis Policy Institute is asking insurance regulators in West Virginia, Pennsylvania, and Delaware to investigate Highmark Blue Cross Blue Shield for what we believe is an effort to profit by diverting copay assistance from drug manufacturers meant to assist patients and splitting the funds between itself a third-party vendor.
In the 2027 Notice of Benefit and Payment Parameters rule proposed today, the administration failed to include promised new regulations on whether copay assistance will count towards patient cost-sharing. “Every day this rule is delayed is another day that insurers and PBMs are pocketing billions of dollars meant for patients who are struggling to afford their drugs,” commented Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “We know that President Trump is squarely focused on drug affordability, and while we are extremely disappointed that this simple step was not yet taken, we urge the administration to act in the very near future.”
Today marks a monumental step in transforming drug pricing and making prescription drugs more affordable for the American people, particularly for those without insurance. For those who do have insurance, TrumpRx may not always be the best option. We hope consumers clearly understand this and urge the Trump administration to expand the site and work with insurers so that TrumpRx payments are counted by insurers. Frankly, if people who have health insurance are using TrumpRx, it demonstrates that the insurer is failing to meet the needs of its paying consumers.
“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.”