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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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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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Comments on the 2026 NBPP proposed rule

Nov 12, 2024

While we appreciate the many steps that you are taking to make healthcare more accessible and affordable for beneficiaries, the majority of this comment on the Proposed NBPP Rule focuses on the need for CMS and related federal agencies to take the necessary steps to increase access and affordability of prescription drugs that should have been included in the Draft NBPP Rule but were not.

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Comments on 2026 draft letter to issuers in the federally-facilitated exchanges

Nov 4, 2024

In our comments we reiterate our profound disappointment with CCIIO and state regulators for not enforcing the strong ACA nondiscrimination patient protections, including a prohibition on adverse tiering in drug formularies and the requirement to cover the drugs included in widely accepted treatment guidelines. We also outline a number of recent examples by insurers, including some new ones, that either CCIIO or states are permitting to operate that do not protect the interests of people living with HIV since they market discriminatory benefit plans designs.

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