Private Insurance

Letter to Missouri House Health Committee supporting HB1941 to ban copay accumulators

We strongly support House Bill 1941 which ensures that health insurers accept and count payments made on behalf of patients toward their deductibles and out-of-pocket maximums. Copay accumulators are harmful policies increasingly implemented by insurers, employers, and pharmacy benefit managers (PBMs). Under these policies, copay assistance provided by drug manufacturers does not count toward patients’ cost-sharing obligations, such as deductibles and out-of-pocket maximums. While patients can initially use the assistance to afford their medications, they often face unexpected and substantial costs later in the year when the assistance runs out, leaving them unable to pay for their prescriptions.

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Arkansas Medicaid community engagement reporting requirement and people with HIV

We write to urge the Arkansas Medicaid program to include an explicit exemption for all people living with HIV from the community engagement reporting required under HR 1. People with HIV are living with a lifelong serious and complex medical condition and have special medical needs: they cannot stay healthy without continuous access to their lifesaving HIV treatment.  Any gap in treatment risks serious health consequences, including failure of viral suppression and the risk of onward transmission.  Longer treatment gaps are potentially disabling, allowing progression to AIDS, after which life expectancy is limited.

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Coverage of preventive services is a legal requirement

Carl Schmid commented on the JAMA Viewpoint piece “Subscription-Based Pricing for Lenacapavir—Learning From Hepatitis C and Cabotegravir,” taking issue with the authors’ dismissal of advocates focus on insurer’s responsibility to follow the law and cover PrEP as a no cost preventive service and offering comments on the hepatitis C subscription model and the need for a comprehensive PrEP program to increase uptake.

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