After court victories, HIV+Hep calls on state insurance regulators to enforce copay assistance rule

Unfortunately, since the court ruling nearly six months ago, we continue to hear from patients complaining that insurers are not counting the copay assistance that they receive, and are being saddled with thousands of dollars in unanticipated out-of-pocket costs for their prescription drugs. Some insurers have told their enrollees that they will not enforce the court ruling without regulator action or a court order.

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From the office of Massachusetts Senate President Karen E. Spilka: Senate passes bill expanding access to HIV prevention drug

“For the first time since PrEP became available eleven years ago, over a third of the people CDC believes could benefit from being on PrEP are being prescribed it. However, there are stark and widening racial, ethnic, and gender disparities in PrEP use in Massachusetts and nationwide,” said Kevin Herwig, Health Policy Manager at HIV+Hepatitis Policy Institute. “Allowing pharmacists to prescribe PrEP, as well as to link people with PrEP clinical services and HIV testing, will help remove barriers to getting HIV preventive medication for people and communities who have not yet been able to benefit from the promise of PrEP.  We thank the Senate, Senate President Spilka, Senator Cyr, and others for supporting this important legislation.”

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HIV+Hep alleges Texas health plan providing substandard & discriminatory HIV drug coverage

Today, the HIV+Hepatitis Policy Institute filed another complaint against an insurer for violating the patient protections included in the Affordable Care Act. This time, the group alleges that Community Health Choice Texas, based in Houston, offers substandard HIV drug coverage by not covering recommended drugs for HIV treatment, including single tablet regimens, and is discriminating against people with HIV by placing most of the drugs that it does cover on the highest and most costly tier.

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Insurer responds to HIV discrimination complaint by lowering patient costs for drugs

Months after 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 on the highest drug tiers, the insurer has released a new mid-year drug formulary that leaves not a single HIV drug on the highest and most costly drug tiers. Instead of 48 HIV drugs, including many generics, on Tiers 5 and 6, there are now none.  As a result, depending on the plan, patients will be paying more reasonable and affordable costs.

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