Prescription Drugs

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Insurers warned that excessive utilization management of prescription drugs is potentially discriminatory

Jul 26, 2022

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. 

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105 Patient groups detail to FTC PBM practices that harm access and affordability of Drugs

May 24, 2022

Today, the HIV+Hepatitis Policy Institute (HIV+Hep) and the Autoimmune Association, along with 103 other organizations representing a broad range of patients across the country, submitted comments to the Federal Trade Commission (FTC) in response to a Request for Information (RFI) on the impact of pharmacy benefit manager (PBM) practices and the ability of patients to access and afford their prescription medications.

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Biden administration takes big step in making drugs affordable for patients: Also strengthens nondiscrimination protections

Apr 28, 2022

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.”

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51 patient groups support Biden administration plans to limit cost-sharing for prescription drugs

Jan 27, 2022

The HIV+Hepatitis Policy Institute and the Autoimmune Association, along with 45 other patient organizations, submitted comments to the U.S. Department of Health and Human Services (HHS) on the Notice of Benefits and Payment Parameters (NBPP) for 2023 proposed rule. The sign-on letter applauds the Biden administration for efforts to make drugs more affordable for patients by requiring insurers on the federal exchange to offer standardized plans with copays rather than co-insurance. However, the groups urge HHS to make improvements to the standard plans in the final rule by increasing the number of drugs not subject to a deductible and lowering some copay amounts.

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Biden administration begins to address patient affordability of medications: but fails to ensure copay assistance counts as patient cost-sharing

Dec 28, 2021

The Biden administration released a proposed rule that will govern how private health plans must operate in 2023 and in doing so, took some steps to limit patient cost-sharing for prescription drugs. However, despite the urging from patient groups, they are not requiring insurers and pharmacy benefit managers (PBMs) to count copay assistance towards patient out-of-pocket cost-sharing and deductibles.

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