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.
Thanks to the leadership of Councilmembers Zachary Parker and Christina Henderson, DC residents who are at risk of HIV will be able to access all forms of PrEP without cost-sharing or prior authorization. This is particularly important since federal preventive health requirements have recently come under attack. We are especially grateful for the amendment to the bill that will require insurers to cover all PrEP drugs, including new long-acting regimens.
“Patients with HIV, hepatitis, and so many other health conditions rely on copay assistance to afford their drugs. Healthcare is already expensive and when insurers add additional barriers and costs, such as not counting copay assistance towards a patient’s deductible, patients’ costs significantly increase, jeopardizing medication adherence and their health,” said Carl Schmid, Executive Director, HIV+Hepatitis Policy Institute. “We applaud Governor Murphy for signing this bipartisan legislation to put an end to hidden insurer practices that drive up patient costs.”
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.
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.