Copay assistance

Testimony for Ad hoc HIV/AIDS Interim Meeting Medicaid Pharmaceutical & Therapeutics Committee Connecticut Division of Health Services

My name is Kevin Herwig, Health Policy Director at the HIV+Hepatitis Policy Institute, a national advocacy organization for people affected by HIV, hepatitis, and other serious or chronic conditions. Thank you for the opportunity to submit public testimony.

Though Connecticut’s statutory exclusion of antiretrovirals from the Medicaid Preferred Drug List has ended, we continue to oppose adding any antiretrovirals for HIV treatment or prevention to the PDL with non-preferred status, which would enable prior authorization and step therapy on those drugs.

HIV treatment selection is highly individualized, based on viral resistance profiles, comorbidities, drug interactions, and tolerability. For over two decades, Connecticut protected people with HIV from utilization management on the antiretroviral drugs they need. Barriers like prior authorization cause non-medical switching and treatment interruptions, falling hardest on the lowest-income, most vulnerable people with HIV, who are seen predominantly in safety-net clinics lacking the staff time and resources to triage utilization management.

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Patient groups letter to CMS Administrator Oz Responding to the request for information on essential health benefits

While the Affordable Care Act (ACA) provides the opportunity for the Secretary of Health and Human Services (HHS) to periodically review the definition of Essential Health Benefits (EHBs), we caution HHS from making any changes or developing any new framework that would reduce the level of prescription drug coverage for beneficiaries. We believe that the current framework and requirements governing prescription drugs that are based on benchmark plans and allow states to add additional benefits are generally working well for patients. Our biggest concerns are the lack of adequate prescription drug coverage, the lack of enforcement of all EHB regulations, and allowing insurers and pharmacy benefit managers (PBMs) to skirt the EHB law and regulations. Below are our recommendations to strengthen prescription drug coverage and enforcement of existing EHB protections.

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Letter to Louisiana Senate in Opposition to Reinstating Copay Maximizer Language in HB 1236

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.

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