The HIV+Hepatitis Policy Institute, a leading organization advocating for equitable and affordable healthcare for individuals living with or at risk of HIV, hepatitis, and other chronic health conditions, strongly supports Senate Bill 45. This vital legislation ensures that health insurers accept and count payments made on behalf of patients toward their deductibles and out-of-pocket maximums.
By passing Senate Bill 17, New Hampshire will join 21 other states, the District of Columbia, and Puerto Rico in protecting consumers purchasing insurance on the private market. This legislation ensures that copay assistance counts toward cost-sharing obligations, preventing patients from facing insurmountable financial barriers to their medications.
I would like to highlight the direct impact of PBM actions on patients, specifically on whether they can access the drug that their provider prescribes and the cost they will pay. Much of this is carried out behind the scenes and without regulation. However, that is beginning to change with more states passing bipartisan legislation to regulate PBMs and even the very partisan Congress is working on federal legislation that will hopefully pass this year.
The HIV+Hepatitis Policy Institute found over 150 employers and issuers utilizing outside vendors as part of their prescription drug benefit for their employees that designate certain drugs as “non-essential health benefits” to evade ACA cost-sharing requirements. Most of them implement copay maximizers, under which they keep all copay assistance from drug manufacturers rather than applying it to the patient’s out-of-pocket costs. Others use an alternative funding program, in which carved out drugs are sourced from patient assistance programs meant for the uninsured or by drug importation.
Our nation can eliminate both HIV and viral hepatitis, but without investing additional resources to accelerate our efforts, we will continue to fall short of these ambitious goals. Increased investment–and certainly not cuts–in surveillance, education, prevention, and care and treatment will lead to further progress in reducing HIV and viral hepatitis, which include taking a syndemic approach to achieve maximum impact.