Private Insurance

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Substandard & discriminatory HIV medication plan design and coverage by Medica in Iowa

Nov 15, 2024

These benefit designs, which discourage enrollment by Iowans living with HIV, are plainly discriminatory.  We urge the Iowa Insurance Division, which reviews, approves, and regulates Marketplace plans in Iowa, to take immediate action against Medica for offering these substandard plans that violate the ACA and its implementing regulations.  We urge you to ensure that these violations are rectified before the new plan year begins.

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Comments on the 2026 NBPP proposed rule

Nov 12, 2024

While we appreciate the many steps that you are taking to make healthcare more accessible and affordable for beneficiaries, the majority of this comment on the Proposed NBPP Rule focuses on the need for CMS and related federal agencies to take the necessary steps to increase access and affordability of prescription drugs that should have been included in the Draft NBPP Rule but were not.

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HIV+Hep & RIPHI & Open Door Health complaint on substandard & discriminatory HIV medication coverage by Harvard Pilgrim Healthcare in Rhode Island

Nov 8, 2024

HIV+Hep, Rhode Island Public Health Institute, and Open Door Health are writing to express our concern about substandard, discriminatory coverage of HIV treatment medications by Harvard Pilgrim Health Care health plans that use its 2025 “Core 5 Tier” formulary in Rhode Island. These plans do not meet the regulatory standards for formulary adequacy in CFR 156.122 (a)(3)(iii)(H) by failing to cover treatment regimens recommended in broadly accepted treatment guidelines and that are indicative of clinical best practice, thereby discouraging enrollment by people living with HIV.

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New Hampshire letter on substandard & discriminatory HIV medication coverage & plan design by Harvard Pilgrim Health Care

Nov 8, 2024

The HIV+Hepatitis Policy Institute is writing to express our concern about substandard, discriminatory coverage of HIV treatment medications by Harvard Pilgrim Health Care health plans that use its 2025 “Core 4 Tier” and “Core 5 Tier” formularies in New Hampshire. These plans do not meet the regulatory standards for formulary adequacy in CFR 156.122 (a)(3)(iii)(H) by failing to cover treatment regimens recommended in broadly accepted treatment guidelines and that are indicative of clinical best practice, thereby discouraging enrollment by people living with HIV.

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Maine letter on substandard & discriminatory HIV medication coverage & plan design by Harvard Pilgrim Health Care

Nov 8, 2024

We, the undersigned organizations and individuals, are writing to express our concern about substandard, discriminatory coverage of HIV treatment medications by Harvard Pilgrim Health Care health plans that use its 2025 “Core 5 Tier” formulary in Maine. These plans do not meet the regulatory standards for formulary adequacy in CFR 156.122 (a)(3)(iii)(H) by failing to cover treatment regimens recommended in broadly accepted treatment guidelines and that are indicative of clinical best practice, thereby discouraging enrollment by people living with HIV.[1] 

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