ACA

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ACA complaint filed with Pennsylvania Insurance Commissioner on Highmark Marketplace Plans

May 4, 2026

We are writing to submit a formal complaint regarding plans offered on the Pennsylvania Marketplace by Highmark Inc. Our formulary review has found that Highmark plans offered in the 2026 plan year appear to violate federal Essential Health Benefits (EHB), discrimination, and preventive health coverage requirements in the following ways: (1) use of a copay maximizer; (2) adverse tiering; and (3) non-compliant coverage of preventive health, specifically of HIV pre-exposure prophylaxis (PrEP).

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ACA complaint filed with West Virginia Insurance Commissioner on Highmark Marketplace Plans

May 4, 2026

We are writing to submit a formal complaint regarding plans offered on the West Virginia Marketplace by Highmark Blue Cross Blue Shield West Virginia.  Our formulary review has found that Highmark plans offered in the 2026 plan year appear to violate federal Essential Health Benefits (EHB), discrimination, and preventive health coverage requirements in the following ways: (1) use of a copay maximizer; (2) adverse tiering; and (3) non-compliant coverage of preventive health, specifically of HIV pre-exposure prophylaxis (PrEP).

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ACA complaint filed with Delaware Insurance Commissioner on Highmark Marketplace Plans

May 4, 2026

We are writing to submit a formal complaint regarding plans offered on the Delaware Marketplace by Highmark Blue Cross Blue Shield Delaware.  Our formulary review has found that Highmark plans offered in the 2026 plan year appear to violate federal Essential Health Benefits (EHB), discrimination, and preventive health coverage requirements in the following ways: (1) use of a copay maximizer; (2) adverse tiering; and (3) non-compliant coverage of preventive health, specifically of HIV pre-exposure prophylaxis (PrEP).

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Letter to the Dept. of Labor on improving transparency into pharmacy benefit manager fee disclosure

Apr 8, 2026

We strongly support the Department of Labor’s proposed rule to increase transparency in pharmacy benefit manager (PBM) compensation and financial arrangements. Greater transparency is essential to improving accountability across the prescription drug supply chain and ensuring that plan fiduciaries have the information necessary to assess the reasonableness of PBM contracts and practices. We urge the Department to finalize and implement this rule without delay, with the recommendations outlined in this letter.

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Comments to CCIIO on the 2027 Draft Letter to Issuers in the Federally-Facilitated Exchanges

Mar 23, 2026

We urge CMS to prioritize oversight of the Marketplace, which serves as an essential safety net within the country’s health insurance system and is of critical importance to people affected by HIV and other serious and chronic health conditions.  We urge CCIIO to reject proposals that decrease access to care by weakening network adequacy, time and distance, and ECP standards; enforce existing rules requiring copay assistance to count towards patient cost-sharing and that covered drugs are considered EHB; and improve the tools CMS provides to regulators to detect formulary coverage that deters enrollment by people living with HIV. As the key regulator of health insurance in the United States, we urge CCIIO to ensure that Marketplace plans provide meaningful, affordable, and non-discriminatory coverage to all. 

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