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Complaint letter to Mississippi insurance commissioner on Blue Cross Blue Shield of Mississippi PrEP & HIV treatment coverage Restrictions

Jun 1, 2026

We are submitting this formal complaint against Blue Cross Blue Shield of Mississippi (BCBSMS) regarding certain formularies offered on the individual and fully insured markets in Mississippi. First, BCBSMS is violating federal preventive health coverage requirements by covering only one of four pre-exposure prophylaxis (PrEP) medications to prevent HIV. Second, BCBSMS’ medical policy deeming long-acting injectables for the treatment of HIV “not medically necessary” does not allow for a meaningful formulary exceptions process as required by federal Essential Health Benefit (EHB) regulations.

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

May 18, 2026

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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ACA complaint filed with Pennsylvania Insurance Commissioner on Highmark Marketplace Plans

May 4, 2026

We are writing to submit a formal complaint regarding plans offered on the Pennsylvania Marketplace by Highmark Inc. Our formulary review has found that Highmark plans offered in the 2026 plan year appear to violate federal Essential Health Benefits (EHB), discrimination, and preventive health coverage requirements in the following ways: (1) use of a copay maximizer; (2) adverse tiering; and (3) non-compliant coverage of preventive health, specifically of HIV pre-exposure prophylaxis (PrEP).

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