Thursday, Oregon’s U.S. Senator Jeff Merkley and Tina Smith
\n(D-MN) were joined by Senators Chris Van Hollen (D-MD), Elizabeth Warren
\n(D-MA), Bernie Sanders (I-VT), Tammy Baldwin (D-WI), Edward J. Markey (D-MA),
\nand Cory Booker (D-NJ) in a letter to AHIP, the trade association representing
\nhealth insurance companies. The letter expresses concerns about the continued
\npractice of unlawfully charging individuals for pre-exposure prophylaxis (PrEP)
\nmedication and related care. <\/p>\n
The Senators’ letter follows a Wednesday court ruling that
\nfurther threatens affordable access to PrEP. As the legal process moves
\nforward, the Senators pressed the health insurance industry to abide by current
\nlaw to provide medication and ancillary services without charge. <\/p>\n
“It has been brought to our attention that enrollees in
\nyour members’ health plans continue to be charged for necessary medications and
\nancillary services-including provider consultations and laboratory
\nservices-contrary to law and additional federal guidance issued by the
\nDepartments of Labor, Health and Human Services, and Treasury,” wrote the
\nSenators. “We write to express our deep concern with these erroneous and
\nunlawful charges, and to request additional information on steps that AHIP is
\ntaking to ensure that its members adhere to federal law and ensure the PrEP
\ndrugs and the full scope of PrEP ancillary services are offered without charge
\nto enrollees.” <\/p>\n
A 2019 ruling by the U.S. Preventive Services Task Force
\n(USPSTF) gave PrEP an “A” rating as prevention intervention for
\npeople at risk of Human Immunodeficiency Virus (HIV). This ruling brought PrEP
\nunder section 2713 of the Public Health Service Act, which requires insurance
\ncoverage for services or interventions that have been given an
\n“”A” or “B” rating from the USPSTF. <\/p>\n
Subsequent guidance, published by the Centers for Medicare
\n& Medicaid Services (CMS) in July 2021, further clarified their ruling.
\nNoting that “plans and issuers must cover PrEP consistent with the USPSTF
\nrecommendation without cost sharing,” the ruling goes on to clarify that
\nPrEP is not just the medication, but also all of its necessary related services
\nincluding testing, screening, and provider visits. Despite this ruling and
\nsubsequent clarification, individuals are still being wrongly charged
\nout-of-pocket expenses relating to their PrEP care. <\/p>\n
“In light of this clear guidance from CMS, we are
\nalarmed by continual reports that patients are routinely billed, either for
\npayment-in-full or for cost-sharing practices, related to medically-appropriate
\nmedications and essential services,” they continued. “These costs can
\nbe daunting. HIV advocates and clinical workers across the county have reported
\nthat many patients are unaware that they do not have to pay out-of-pocket for
\nPrEP and ancillary services, assuming that many of these costs are simply
\nnecessary for being on PrEP medication.” <\/p>\n
The Senators’ letter highlights the inequities in PrEP
\nuptake across communities at higher risk for HIV-including Black and Hispanic
\ncommunities and transgender women-due to limited access to financial resources
\nneeded to cover costs of PrEP and associated medical visits and laboratory
\ntests, among other factors. <\/p>\n
In light of these concerns, the lawmakers ask the following
\nquestions and request a response from AHIP within 30 days: <\/p>\n
The letter is supported by PrEP4ALL, the HIV+Hepatitis
\nPolicy Institute, the Center for Health and Democracy, and NMAC. <\/p>\n
“Unfortunately we have documented dozens of cases of
\ninsurers still charging patients out-of-pocket fees for PrEP-related care, a
\nyear after CMS and the Department of Labor issued their guidance,” said
\nKenyon Farrow, Managing Director of Advocacy & Organizing with
\nPrEP4ALL.?”Ending the HIV epidemic will require us to ensure everyone with
\ninsurance be able to get PrEP services with no cost-sharing, as the rule
\nintended. We applaud Sen. Merkley and Sen. Smith\u2019s tireless advocacy on behalf
\nof patients.” <\/p>\n
“We appreciate Senators Merkley and Smith\u2019s leadership
\nand all their colleagues desire to ensure that the preventative service
\nprovisions of the Affordable Care Act are properly implemented. Private
\ninsurers must provide PrEP drugs and associated services without patient
\ncost-sharing. We are receiving too many complaints from PrEP users that this is
\nnot always happening. We trust with this letter insurers will ensure full
\ncompliance,” said Carl Schmid, Executive Director of the HIV+Hepatitis
\nPolicy Institute. <\/p>\n<\/p>\n
“While appalling, it\u2019s sadly not shocking to see Big
\nHealth Insurance wrongfully billing enrollees for medications and ancillary
\nservices as part of a PrEP regimen to prevent HIV, despite crystal clear
\nguidance from the Departments of Health and Human Services, Labor, and Treasury
\nnot to do so,” said Wendell Potter, President of the Center for Health and
\nDemocracy. “We\u2019re grateful for the leadership of Senators Merkley and
\nSmith for sending this letter, underscoring their understanding of the
\neffectiveness of PrEP and their compassion for those at risk and their
\nfamilies.” <\/p>","protected":false},"excerpt":{"rendered":"
Thursday, Oregon’s U.S. Senator Jeff Merkley and Tina Smith (D-MN) were joined by Senators Chris Van Hollen (D-MD), Elizabeth Warren (D-MA), Bernie Sanders (I-VT), Tammy Baldwin (D-WI), Edward J. Markey (D-MA), and Cory Booker (D-NJ) in a letter to AHIP, the trade association representing health insurance companies. The letter expresses concerns about the continued practice […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"categories":[26],"tags":[],"class_list":["post-1992","post","type-post","status-publish","format-standard","hentry","category-in-the-news"],"acf":[],"yoast_head":"\n