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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 Massachusetts Budget Conference Committee supporting FY27 HIV PrEP access provisions and HIV/AIDS funding

May 29, 2026

As you work to reconcile the Massachusetts Fiscal Year 2027 budget, we write to thank you for your longstanding leadership and advocacy on behalf of the HIV community. We respectfully urge the Conference Committee to adopt two critical HIV priorities passed by the House: (1) the comprehensive HIV PrEP access provisions, and (2) the robust $35 million funding level for the state’s HIV/AIDS and infectious disease programs.

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Letter to all Medicaid expansion states requesting HIV exemption from community engagement requirements

May 7, 2026

People with serious and complex medical conditions or special medical needs are statutorily exempt from the community engagement requirement. Federal implementation guidance due by June is expected to provide further detail on how states may implement this exemption.  While we are seeking a federal exemption, under the law, states are allowed to define which populations qualify for the exemption.  We urge Alaska Medicaid to explicitly state that HIV is a serious and complex medical condition and that all people living with HIV (both symptomatic and asymptomatic) have special medical needs and fall under this exemption. 

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Letter to Massachusetts Senate supporting HIV PrEP Access Provisions and FY27 HIV/AIDS Funding

May 6, 2026

We write to thank the Massachusetts Senate for your longstanding leadership and advocacy on behalf of the HIV community and to urge you to champion two critical HIV priorities during Senate consideration of the Fiscal Year 2027 budget: (1) the comprehensive HIV PrEP access provisions adopted by the House, and (2) robust funding for the state’s HIV/AIDS and infectious disease programs.

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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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