After a tumultuous year of proposed program cuts and eliminations, Congress has agreed to reject them and instead has maintained funding for domestic HIV prevention and treatment programs on a bipartisan basis. Now, the Trump administration must focus its attention on properly implementing these programs in order to get the nation back on track to end HIV in the U.S.
“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.”
“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.”
“Forcing a person who has employer sponsored health insurance to sign up with an unknown third-party vendor to receive their life-saving drug supplied by a foreign country not only is illegal but jeopardizes the health and safety of patients,” commented Carl Schmid, Executive Director of the HIV+Hepatitis Policy Institute. “In an effort to evade actual coverage of specific prescription drugs that the health insurance plan states it covers, middlemen are profiting by scheming to set up so-called ‘alternative funding programs.’ While federal regulators should be shutting them down, in the meantime, the courts must step in to protect patients.”
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.