By passing Senate Bill 203, Wisconsin will join 25 other states, the District of Columbia, and Puerto Rico in protecting consumers purchasing insurance on the private market. This legislation ensures that copay assistance counts toward cost-sharing obligations, preventing patients from facing insurmountable financial barriers to their medications.
HIV+Hep filed an amicus brief in support of Iowa’s PBM reform law that requires copay assistance to count for Rx’s not only in ACA plans but for the first time, employer plans. PBMs contend it is unlawful under ERISA. In our brief we explain to the US 8th Circuit Court of Appeals why it is not.
We, the undersigned 64 organizations, on behalf of people and communities affected by HIV, their care providers, public health practitioners, and community-based organizations, write in response to statements made by CVS Health to the media that it does not intend to cover Yeztugo (lenacapavir), a twice-yearly long-acting injectable drug recently approved by the FDA as pre-exposure prophylaxis (PrEP) for the prevention of HIV.[1] We urge you to reconsider this decision and cover Yeztugo without delay.
While we share your commitment to addressing the high cost of prescription drugs, we strongly oppose A8136, legislation that would explicitly authorize the use of copay maximizer programs in New York’s health insurance market.
Copay accumulator and maximizer programs block manufacturer copay assistance from counting toward a patient’s deductible or out-of-pocket maximum. As a result, patients face sudden and unaffordable cost spikes mid-year, while PBMs, insurers, and often third-party vendors retain the financial value of the assistance. These programs are commonly deployed by vertically integrated entities, raising concerns that internal financial incentives are being prioritized over patient affordability and therapeutic continuity.