Cost-sharing

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Comments on 2025 draft letter to issuers in the federally-facilitated exchanges

Jan 2, 2024

The HIV+Hepatitis Policy Institute submitted comments recommending that the 2025 Draft Letter to Issuers in the Federal-facilitated Exchange include a reminder to issuers that copay assistance must be counted for all but brand name drugs with a generic equivalent, plans be flagged for adverse tiering when all or a majority of drugs to treat a certain condition are on the highest tiers, CMS takes a more proactive role in enforcement action against insurers that violate the law, and CCIIO fully reviews plans for benefit designs that discriminate against certain individuals.

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Support for MA state bills to address barriers to HIV prevention medication

Nov 14, 2023

On behalf of the HIV+Hepatitis Policy Institute, we respectfully submit this testimony in support of H.1085/S.619: An Act to address barriers to HIV prevention medication. We need to ensure that everyone is able to benefit from the results of the latest scientific innovations in HIV prevention.  We urge the passage of this important bill to ensure that all Bay Staters using commercial insurance can access PrEP without a financial barrier or delay. 

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Expanding PrEP access now

Sep 20, 2023

In public comments to the President’s Advisory Council on HIV/AIDS, the HIV+Hepatitis Policy Institute suggests ways that the federal government can improve PrEP uptake: 1) having CMS ensure that private insurers comply with ACA $0 cost-sharing requirements, 2) having the CDC’s Division of HIV Prevention dedicate more funding for PrEP, and 3) having HRSA ensure that the community health centers PrEP program works effectively.

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Comments on Medicare NCD for PrEP using antiretroviral therapy

Aug 11, 2023

With deep and widening racial, ethnic, and gender disparities in uptake, access to PrEP through Medicare is of paramount importance to making sure that Medicare beneficiaries are able to benefit from the widening array of PrEP options without cost-sharing.  Medicare beneficiaries (including those dually eligible for Medicaid) comprise 10 percent of the population using PrEP, including both individuals over 65 as well as disabled individuals under 65.  We thank CMS for making clear that all FDA-approved forms of PrEP would be available without cost-sharing.  This means that Medicare beneficiaries will have unfettered access to future novel forms of PrEP immediately after FDA approval. 

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