PBMs

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50 patient groups comment in response to the request for information on essential health benefits [CMS-9898-NC]

Jan 31, 2023

We believe that the EHB regulations governing prescription drugs have generally been working well for patients; however, we propose some areas for improvement and are very concerned that there has been a lack of enforcement of the EHB regulations, an erosion of essential health benefits over the years, and some insurers and pharmacy benefit managers (PBMs) are devising ways to skirt the intent of the EHB law and regulations. 

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71 patient groups comment on the NBPP for 2024 proposed rule

Jan 30, 2023

We, the undersigned 71 organizations, on behalf of millions of patients and American consumers who live with complex conditions such as HIV, autoimmune diseases, cancer, diabetes, lupus, hemophilia, mental illness, hepatitis, neurological diseases, and other chronic illnesses, write to comment on the Notice of Benefits and Payment Parameters for 2024 Proposed Rule.  The patients we represent appreciate all you are doing to make healthcare more accessible and affordable for beneficiaries. While there are several components of the Proposed Rule that many of us will comment on elsewhere, this letter focuses on those issues that impact access and affordability of prescription drugs.

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Support for New York’s S.5299-A/A.1741-A on copay assistance

Jul 18, 2022

The HIV+Hepatitis Policy Institute is a leading HIV and hepatitis policy organization promoting quality and affordable healthcare for people living with or at risk of HIV, hepatitis, and other serious and chronic health conditions. We strongly support S.5299-A/A.1741-A, which would require health insurers to accept and count payments made on behalf of patients towards deductibles and out-of-pocket maximums. We urge you to sign this legislation into law as soon as possible.

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Support for D.C.’s “Copay Accumulator Amendment Act of 2021”

Jun 27, 2022

HIV+Hep strongly supports the “Copay Accumulator Amendment Act of 2021” (Bill 24-0557) introduced by Chairman Gray and four councilmembers.  It simply requires that the copay assistance beneficiaries receive count towards their out-of-pocket obligation.  By passing this law, DC will join 14 other states (Arkansas, Arizona, Connecticut, Georgia, Illinois, Kentucky, Louisiana, Maine, Oklahoma, North Carolina, Tennessee, Washington, West Virginia, and Virginia) and Puerto Rico in protecting consumers by assuring their copay assistance will count towards cost-sharing obligations.

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105 groups comment on the role of PBMs on patient access and affordability of prescription drugs

May 24, 2022

We, the undersigned 105 organizations, on behalf of millions of patients and Americans who live with complex conditions such as HIV, autoimmune diseases, cancer, diabetes, kidney disease, lupus, hemophilia, mental illness, and hepatitis write in response to the Federal Trade Commission (FTC) request for public comment on the impact of pharmacy benefit manager (PBM) practices on consumers.  Specifically, we offer comments on how PBMs impact the health and well-being of patients who receive their health coverage through the private insurance market.  While most people think insurers make the majority of decisions regarding health coverage and affordability, when it comes to prescription drugs, it is the PBMs that drive much of the decisions as to what medications a beneficiary can access and how much they pay for them.  We commend the FTC for its leadership to investigate the impact that PBM practices have on the patient communities we serve and believe this represents a critical step forward to improving patient access and affordability to necessary medications.

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