Drug Pricing

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Substandard & discriminatory HIV medication plan design and coverage by Medica in Iowa

Nov 15, 2024

These benefit designs, which discourage enrollment by Iowans living with HIV, are plainly discriminatory.  We urge the Iowa Insurance Division, which reviews, approves, and regulates Marketplace plans in Iowa, to take immediate action against Medica for offering these substandard plans that violate the ACA and its implementing regulations.  We urge you to ensure that these violations are rectified before the new plan year begins.

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HIV+Hep & RIPHI & Open Door Health complaint on substandard & discriminatory HIV medication coverage by Harvard Pilgrim Healthcare in Rhode Island

Nov 8, 2024

HIV+Hep, Rhode Island Public Health Institute, and Open Door Health are writing to express our concern about substandard, discriminatory coverage of HIV treatment medications by Harvard Pilgrim Health Care health plans that use its 2025 “Core 5 Tier” formulary in Rhode Island. These plans do not meet the regulatory standards for formulary adequacy in CFR 156.122 (a)(3)(iii)(H) by failing to cover treatment regimens recommended in broadly accepted treatment guidelines and that are indicative of clinical best practice, thereby discouraging enrollment by people living with HIV.

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New Hampshire letter on substandard & discriminatory HIV medication coverage & plan design by Harvard Pilgrim Health Care

Nov 8, 2024

The HIV+Hepatitis Policy Institute is writing to express our concern about substandard, discriminatory coverage of HIV treatment medications by Harvard Pilgrim Health Care health plans that use its 2025 “Core 4 Tier” and “Core 5 Tier” formularies in New Hampshire. These plans do not meet the regulatory standards for formulary adequacy in CFR 156.122 (a)(3)(iii)(H) by failing to cover treatment regimens recommended in broadly accepted treatment guidelines and that are indicative of clinical best practice, thereby discouraging enrollment by people living with HIV.

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Maine letter on substandard & discriminatory HIV medication coverage & plan design by Harvard Pilgrim Health Care

Nov 8, 2024

We, the undersigned organizations and individuals, are writing to express our concern about substandard, discriminatory coverage of HIV treatment medications by Harvard Pilgrim Health Care health plans that use its 2025 “Core 5 Tier” formulary in Maine. These plans do not meet the regulatory standards for formulary adequacy in CFR 156.122 (a)(3)(iii)(H) by failing to cover treatment regimens recommended in broadly accepted treatment guidelines and that are indicative of clinical best practice, thereby discouraging enrollment by people living with HIV.[1] 

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Illinois testimony on PBM treatment of specialty drugs

Sep 11, 2024

I would like to highlight the direct impact of PBM actions on patients, specifically on whether they can access the drug that their provider prescribes and the cost they will pay. Much of this is carried out behind the scenes and without regulation. However, that is beginning to change with more states passing bipartisan legislation to regulate PBMs and even the very partisan Congress is working on federal legislation that will hopefully pass this year.

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