Testimony, Comments, & Letters

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Oregon PDAB comments on HIV drug affordability, copay accumulators, and alternative funding programs

Dec 13, 2024

As the Oregon PDAB begins reviewing its initial list of prescription drugs, we believe that affordability reviews of HIV medications fail to fully account for the intricacies of the existing HIV safety net, which makes lifesaving HIV treatments affordable for most people. We also want to raise numerous factors in the global HIV drug ecosystem that would be difficult for a state to consider.  Finally, we reiterate our support for the proposed legislative policy recommendations that enhance transparency around insurers’ use of copay accumulators, maximizers, and the need to consider alternative funding programs.

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PACHA comments urging enforcement of ACA non-discriminatory regulations on HIV treatment

Dec 12, 2024

The HIV+Hepatitis Policy Institute again urges the Secretary to take administrative action to ensure that the ACA’s non-discrimination regulations are fully enforced. In the states where CCIIO has jurisdiction, it must investigate complaints and ensure plans are in compliance. In the other states, CMS should update tools to empower states to review plans as they are filed annually to ensure that HIV drugs included in national treatment guidelines are covered, and that HIV drugs are properly tiered. CMS regulations clarifying that these practices are presumptively discriminatory date were first promulgated in 2016, and further updated in 2022, but the tools CMS provides to review the plans do not yet provide adequate protections to ensure that people with HIV are not discouraged from enrollment. Finally, the HHS Office of Civil Rights should be brought to the table in this process to further assess bias and discriminatory review with regard to insurance plans and their coverage of HIV drugs.

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Support for NJ S3818 to ensure copay assistance counts toward patients costs

Dec 11, 2024

More and more insurers and PBMs have instituted harmful policies that do not apply copay assistance towards beneficiaries’ out-of-pocket costs and deductibles. Currently, 2 out of 6 health plans available on the New Jersey individual marketplace have language in their individual health plan documents stating that copay assistance may not be counted.  When implementing these policies, the insurer collects the copay assistance from the drug manufacturer and the patient is able to pick up their medication, but that copay assistance is not counting towards the beneficiary’s deductible or out-of-pocket obligation. Then, later in the year, when the beneficiary goes to pick up their drug, they find out that copay assistance did not count and are stuck with a huge, unexpected copay. In order to pick up their drug they are forced to come up with often thousands of dollars, which few people have. Insurers are double dipping: first they receive the copay assistance from the drug manufacturer and then they collect it again from the beneficiary.

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Comments on updated HIV & hepatitis strategic plans

Dec 5, 2024

As a policy and advocacy organization we work to ensure there are the proper policies, programs, and funding to implement the Strategic Plans. We also refer to them in our work with the Congress, media, and the public to help educate them on the strategic plans and national goals included in each of the plans. We use them to measure our progress in meeting the goals. We not only use them to advocate before the Congress but also within government agencies and leadership to hold them accountable to ensure the goals are reached and that proper policies and programs are in place with sufficient funding.

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ACA Appropriations Biden administration CDC co-pay accumulators Congress copay copay accumulator Copay accumulators Copay assistance Cost-sharing COVID-19 Drug Pricing FDA Gay men healthcare Hepatitis Hepatitis B hepatitis C Hepatitis Prevention HHS HIV HIV Prevention Insurers Medicaid medicare Medicare Part D NAIC NIH PBM PBMs PrEP Prescription Drugs Private Insurance Ryan White Program state STDs Syringe services Testing transparency Treatment Trump administration women

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