ACA

Substandard and discriminatory HIV medication coverage and plan design by Community Health Choice Texas

Oct 7, 2024

We are writing to express our continuing concern about substandard, discriminatory coverage of HIV treatment medications on Community Health Choice Texas “Premier” and “Select” health insurance plans. As we have previously stated, the formularies for these plans, among other things, do not meet the regulatory standards for formulary adequacy in CFR 156.122 (a)(3)(iii)(H) by failing to cover treatment regimens specified in broadly accepted treatment guidelines and that are indicative of clinical best practice, and by discouraging enrollment by people living with HIV.

Concerns with Rhode Island Drug Cost Review Commission (S 2719)

May 14, 2024

Given the important nature of prescription drugs to the life-saving treatment of HIV and hepatitis B, and now the cure of hepatitis C and the prevention of HIV, we have long advocated for affordable access to prescription medications. We applaud your commitment to ensuring that beneficiaries can access and afford the prescription medications that their providers prescribe. While we support and share the committee’s intent to lower out-of-pocket costs for consumers, we believe the proposed Rhode Island Drug Cost Review Commission (S 2719) would neither benefit patients in the long run nor result in reducing patients’ costs.

Support for NH SB 354 relative to insurance cost-sharing calculations

Apr 29, 2024

It is a pleasure to reiterate our strong support for Senate Bill 354-FN (“relative to insurance cost-sharing calculations”) which would require health insurers and pharmacy benefit managers to include any amount paid by the enrollee or on their behalf in calculating an enrollee’s contribution to cost-sharing requirements. Now that the Senate successfully passed the bill, we are pleased that you will be holding a hearing on this important issue and that you too will pass the bill.

Support for CA AB 2180 “Health Care Coverage: Cost Sharing”

Mar 25, 2024

HIV+Hep strongly supports AB 2180. It simply requires that the copay assistance which beneficiaries receive counts towards their out-of-pocket obligations. By passing this law, California will join 19 other states (Arkansas, Arizona, Colorado, Connecticut, Delaware, Georgia, Illinois, Kentucky, Louisiana, Maine, Oklahoma, North Carolina, New Mexico, New York, Tennessee, Texas, Washington, West Virginia, and Virginia), Puerto Rico and the District of Columbia in protecting consumers by assuring their copay assistance will count towards cost-sharing obligations.

Comments on ERISA’s 50th anniversary–reforms to increase affordability and quality in employer-sponsored health coverage

Mar 15, 2024

Employer-sponsored insurance is the most common form of health insurance in the United States, covering over 60 percent of the population under 65.[1] As we detail below, many employers have begun to create new health insurance barriers that prevent employees and their family members from accessing the medications they need to stay alive and healthy. Our comments focus on certain novel benefit designs that have become more prevalent in recent years among employer-sponsored insurance plans: copay accumulators, copay maximizers, and alternative funding programs, as well as the practice of skirting ACA requirements by designating certain specialty medications as non-Essential Health Benefits.

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