private insurers

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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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Letter to California Senate supporting Support SB 1199 to ban copay accumulators

Mar 19, 2026

By passing SB 1199, California will join 26 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.

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Updated MN Letter on Medica’s substandard & discriminatory HIV medication plan design and coverage

Dec 2, 2025

We are pleased to note substantial improvements in Medica’s coverage and trust that our complaints in Minnesota and Iowa against Medica played a major role in these improvements.  We know that the Iowa Commissioner worked with Medica and hope that you did as well.  Despite these improvements, substantial issues remain with Medica’s coverage and tiering of HIV medications and we are submitting additional data comparing Medica’s benefit designs with those of other issuers on the Minnesota Marketplace.

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