As Congress considers reforms to private health insurance, we urge you to ensure that coverage provides meaningful access to the medications, services, and care patients need and protects them from practices that shift costs or create unnecessary barriers to treatment.
We are writing to urge you to require Blue Cross Blue Shield Federal Employee Plan (FEP), the largest carrier in the Federal Employees Health Benefits (FEHB) Program, to fully cover long-acting injectable PrEP products. We are most concerned that BCBS is charging cost-sharing for Yeztugo (lenacapavir), violating OPM’s requirement that carriers cover all FDA-approved PrEP drugs without cost-sharing.
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.
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.
Copay assistance programs exist to help patients afford the high costs of essential medications. For people living with HIV and hepatitis B, lifelong daily treatment is required. For hepatitis C, a curative treatment is available but often comes with a high upfront cost. Without assistance that counts toward out-of-pocket limits, patients in high-deductible or high-cost-sharing plans may be forced to go without treatment. Allowing maximizer programs to flourish, particularly under the false premise that they benefit patients, only reinforces barriers to treatment.