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, and neurological conditions write to comment on the Proposed Rulemaking for ACA Section 1557 Nondiscrimination in Health Programs and Activities. As detailed below, we are extremely pleased that you have taken meaningful steps to improve upon current regulations to ensure that people are not discriminated against in healthcare. In several instances, you have proposed to restore protections that had been included in the past but later withdrawn. In other instances, you have provided further clarity on what constitutes discrimination. In any instance, we emphasize that the law and whatever is finalized in regulation must be strictly enforced.
HIV/AIDS groups letter in support of MassHealth making injectable long-acting PrEP available without barriers
HIV/AIDS groups are concerned that MassHealth (Massachusetts Medicaid) has not yet added cabotegravir, a new long-acting injectable form of pre-exposure prophylaxis (PrEP) to prevent HIV, to its formulary. We urge MassHealth to make sure injectable long-acting cabotegravir as PrEP is available on formulary without any barriers to access, such as utilization management or prior authorization requirements.
64 organizations request expedited Medicare National Coverage Determination for long-acting injectable PrEP
We are pleased that the Centers for Medicare and Medicaid Services (CMS) has accepted a request for a National Coverage Determination (NCD) for cabotegravir, a new long-acting injectable form of pre-exposure prophylaxis (PrEP) to prevent HIV. A National Coverage Determination is the only pathway to coverage under Medicare Part B for a provider-administered drug. We have, however, been disappointed to learn that CMS has given no timeline for action on this National Coverage Determination, which will make this new long-acting PrEP medication out of reach for potential PrEP users. Combined with a USPSTF recommendation, an NCD will also make the drug available to Medicare Part B beneficiaries without cost-sharing, thus eliminating one of the biggest barriers to PrEP uptake.
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.
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.