We write to express our support for the proposed settlement with Express Scripts, Inc. and its affiliated entities (collectively “ESI”), to highlight several provisions that will significantly improve affordability and access to medications for patients and propose critical enhancements to further strengthen the order’s protections.
We, the undersigned HIV service providers, advocates, and public health organizations in the District of Columbia, write in strong support of the PrEP DC Amendment Act (B26-0159) and urge the Council to pass the bill without change on its final reading. Requiring coverage of all PrEP drugs is essential to increasing uptake, supporting adherence, and reducing new HIV cases in the District. Allowing individuals and their providers to choose the PrEP option that works best for them reflects current best practices in HIV prevention and is consistent with current federal protections.
We strongly support House Bill 1941 which ensures that health insurers accept and count payments made on behalf of patients toward their deductibles and out-of-pocket maximums. Copay accumulators are harmful policies increasingly implemented by insurers, employers, and pharmacy benefit managers (PBMs). Under these policies, copay assistance provided by drug manufacturers does not count toward patients’ cost-sharing obligations, such as deductibles and out-of-pocket maximums. While patients can initially use the assistance to afford their medications, they often face unexpected and substantial costs later in the year when the assistance runs out, leaving them unable to pay for their prescriptions.
While we share a commitment to addressing the high cost of prescription drugs, we have significant concerns with HB483 that creates a Prescription Drug Affordability Board (PDAB). We believe it will not translate into lower drug costs for patients and may dampen future drug development.
We write to urge you to include an explicit exemption for all people living with HIV in upcoming federal guidance relating to the new Medicaid community engagement requirement mandated by HR 1.
People with HIV are living with a lifelong serious and complex medical condition and have special medical needs: they cannot stay healthy without continuous access to their lifesaving HIV treatment. Any gap in treatment risks serious health consequences, including failure of viral suppression and the risk of onward transmission. Longer treatment gaps are potentially disabling, allowing progression to AIDS, after which life expectancy is limited.