We write to express our support for the proposed settlement with with Caremark Rx, L.L.C. and Zinc Health Services, LLC to highlight several provisions that will significantly improve affordability and access to medications for patients and propose critical enhancements to further strengthen the order’s protections.
HIV+Hepatitis Policy Institute and the Arthritis Foundation sent a letter to PCMA raising concerns about how its members will present TrumpRx prices to insured patients. The groups urged PCMA members to clearly disclose whether TrumpRx purchases will count toward patients’ deductibles and out-of-pocket maximums, warning that a lower cash price today could ultimately result in higher costs over the course of the plan year.
The undersigned Consumer Representatives to the National Association of Insurance Commissioners (NAIC) write to express our deep concern regarding your recent public statements indicating that you do not intend to enforce the Affordable Care Act’s preventive services requirements with respect to coverage of pre-exposure prophylaxis (PrEP) for HIV prevention. Under federal law, which was recently upheld by the U.S. Supreme Court in Kennedy v. Braidwood Management, Inc., insurers must cover without cost sharing evidence-based preventive services that receive a grade “A” and “B” from the U.S. Preventive Services Task Force (USPSTF). Also, under federal law, it is the responsibility of state regulators to ensure that insurers are in compliance, and that health coverage is administered fairly and consistently.
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.
The HIV+Hepatitis Policy Institute is a national organization promoting quality and affordable healthcare for people living with or at risk of HIV, hepatitis, and other serious and chronic health conditions. We write in strong support of House Substitute 1 for House Bill 200 and respectfully urge you to sign this critical legislation into law. This bill protects Delawareans at risk of HIV by preserving access to highly effective pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) medications and related services without cost-sharing, prior authorization, or step therapy barriers.