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 Maryland Senate Bill 773. This vital legislation ensures that health insurers accept and count payments made on behalf of patients toward their deductibles and out-of-pocket maximums.
As the Subcommittee examines how reining in pharmacy benefit managers (PBMs) will drive competition and lower costs for patients, we urge Congress to pass meaningful reforms that will ensure patient access to life-saving medications and address the harmful, profit-driven practices of PBMs. For too long, pharmacy benefit managers have profited at the expense of patients living with chronic conditions. These middlemen, who now control 80% of prescription drug claims dictate, with little transparency or oversight, which medications insurers cover, how much patients pay and which administrative hoops patients and providers must jump through to access prescribed treatments.[i] PBMs exploit their dominant market position to extract profits at the expense of patients, particularly those managing chronic conditions such as cancer, diabetes, and HIV. Chronic conditions affect more than 130 million Americans and as of 2022, approximately 1.2 million people were living with HIV nationwide.
When patients are forced to forego their medications due to high costs, the consequences are severe—not just for individual health outcomes, but also for public health and healthcare system costs. Policies that limit access to copay assistance exacerbate these challenges, disproportionately affecting those who are already vulnerable. LB158 represents an essential safeguard against harmful insurer practices, ensuring equitable access to life-saving treatments for Nebraskans.
While we share a commitment to addressing the high cost of prescription drugs, we have significant concerns with Virginia H.B. 1724 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.
As the Committee considers the nomination of Mehmet C. Oz, M.D. to serve as CMS Administrator, the HIV+Hepatitis Policy Institute urges you to ensure the nominee will uphold a stalwart commitment to a comprehensive healthcare system that includes a robust private insurance market, along with strong Medicaid and Medicare programs. All are critical to making American healthier again and in ending the chronic diseases of HIV and hepatitis. Please find attached suggested questions for Dr. Oz concerning 1) a federal court decision regarding copay assistance for prescription drugs, 2) preventive services coverage under the ACA, 3) private insurance prescription drug coverage and affordability policies, and 4) the Medicare Part D six protected classes of prescription drugs.