State

Testimony for Ad hoc HIV/AIDS Interim Meeting Medicaid Pharmaceutical & Therapeutics Committee Connecticut Division of Health Services

My name is Kevin Herwig, Health Policy Director at the HIV+Hepatitis Policy Institute, a national advocacy organization for people affected by HIV, hepatitis, and other serious or chronic conditions. Thank you for the opportunity to submit public testimony.

Though Connecticut’s statutory exclusion of antiretrovirals from the Medicaid Preferred Drug List has ended, we continue to oppose adding any antiretrovirals for HIV treatment or prevention to the PDL with non-preferred status, which would enable prior authorization and step therapy on those drugs.

HIV treatment selection is highly individualized, based on viral resistance profiles, comorbidities, drug interactions, and tolerability. For over two decades, Connecticut protected people with HIV from utilization management on the antiretroviral drugs they need. Barriers like prior authorization cause non-medical switching and treatment interruptions, falling hardest on the lowest-income, most vulnerable people with HIV, who are seen predominantly in safety-net clinics lacking the staff time and resources to triage utilization management.

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NAIC consumer reps letter to MS Comm. Chaney on preventive services

The undersigned Consumer Representatives to the National Association of Insurance Commissioners (NAIC) write to express our deep concern regarding your recent public statements indicating that you do not intend to enforce the Affordable Care Act’s preventive services requirements with respect to coverage of pre-exposure prophylaxis (PrEP) for HIV prevention. Under federal law, which was recently upheld by the U.S. Supreme Court in Kennedy v. Braidwood Management, Inc., insurers must cover without cost sharing evidence-based preventive services that receive a grade “A” and “B” from the U.S. Preventive Services Task Force (USPSTF). Also, under federal law, it is the responsibility of state regulators to ensure that insurers are in compliance, and that health coverage is administered fairly and consistently.

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Letter to Delaware Governor Meyer in Support of Preserving PrEP and PEP Access

The HIV+Hepatitis Policy Institute is a national organization promoting quality and affordable healthcare for people living with or at risk of HIV, hepatitis, and other serious and chronic health conditions. We write in strong support of House Substitute 1 for House Bill 200 and respectfully urge you to sign this critical legislation into law. This bill protects Delawareans at risk of HIV by preserving access to highly effective pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) medications and related services without cost-sharing, prior authorization, or step therapy barriers.

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Complaint letter to Mississippi insurance commissioner on Blue Cross Blue Shield of Mississippi PrEP & HIV treatment coverage Restrictions

We are submitting this formal complaint against Blue Cross Blue Shield of Mississippi (BCBSMS) regarding certain formularies offered on the individual and fully insured markets in Mississippi. First, BCBSMS is violating federal preventive health coverage requirements by covering only one of four pre-exposure prophylaxis (PrEP) medications to prevent HIV. Second, BCBSMS’ medical policy deeming long-acting injectables for the treatment of HIV “not medically necessary” does not allow for a meaningful formulary exceptions process as required by federal Essential Health Benefit (EHB) regulations.

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