Members of AHIP have been reported to illegally charge patients for necessary medications and ancillary services essential to preventing HIV infection.
WASHINGTON (September 8, 2022) — Senator Edward J. Markey, Democrat, Massachusetts, announced today that Chris Van Hollen, Democrat, Massachusetts, Elizabeth Warren, Democrat, Massachusetts, and Bernie Sanders, I-Vt. Tammy Baldwin (D-Wisconsin) in a letter to AHIP, the trade association representing health insurance, led by Senators Jeff Markley (D-Oregon) and Tina Smith (D-Minnesota). ) and Cory Booker (DN.J.) Companies. The letter expresses concern about the continuing practice of illegally billing individuals for pre-exposure prophylaxis (PrEP) medications and related care.
The senator’s letter follows Wednesday’s court ruling that further threatens affordable access to PrEP. As the legal process progresses, senators called on the health insurance industry to comply with current laws and provide free medicines and ancillary services.
“Your Member’s health plan subscribers are not permitted to take necessary medications or incidental medications, including health care provider consultation and testing services, contrary to law and additional federal guidance issued by the Department of Labor, Health, and Labor.” We have found that we continue to be billed for the services we provide, Human Services, and the Ministry of Finance.” wrote Senator. “We express our deepest concern about these false and unlawful claims and the steps AHIP is taking to ensure that its members comply with federal law and that the full range of PrEP drugs and PrEP ancillary services are provided. I am writing to request additional information about the action being taken, free of charge for registrants.”
A 2019 ruling by the United States Preventive Services Task Force (USPSTF) gave PrEP an ‘A’ rating as a preventive intervention for people at risk for the human immunodeficiency virus (HIV). The ruling made PrEP under Section 2713 of the Public Health Services Act, which mandates insurance coverage for services or interventions rated “A” or “B” by the USPSTF.
Subsequent guidance issued by the Centers for Medicare & Medicaid Services (CMS) in July 2021 further clarified that ruling. “Plans and issuers should cover PrEP as recommended by the USPSTF without sharing costs,” he noted, noting that PrEP is not just a drug, but all the necessary tests, screenings, provider visits, etc. Clarified to include related services. Despite this ruling and subsequent clarifications, individuals are still incorrectly charged for out-of-pocket costs related to PrEP care.
“In light of this clear guidance from CMS, we continue to recognize that patients are routinely billed for full or cost-sharing practices related to medically appropriate medications and essential services. We are wary of unsolicited reports.” they continued. “These costs can be daunting. HIV advocates and clinicians across the county report that many patients are unaware that they do not have to pay out-of-pocket for PrEP and ancillary services. We believe that many of these costs are simply necessary to receive PrEP medication.”
The senator’s letter highlights the inequity of PrEP access in communities at high risk of HIV, including black and Hispanic communities and transgender women. cause.
In light of these concerns, legislators ask the following questions and request a response from AHIP within 30 days.
- To ensure that health care plans comply with federal regulations that clarify the availability of PrEP and ancillary services for patients free of charge, AHIP currently provides what information to support its members. Or do you provide guidance?
- AHIP does not recommend that members provide information or materials to registrants to ensure that patients understand that PrEP, including ancillary services, should be provided to registrants free of charge. what is it?
- How does AHIP work with laboratories and healthcare providers to ensure accurate coding of appointments and services so that registrants are not incorrectly billed for these services?
- How does AHIP work with partners to fully understand the scope of the problem, both in terms of the number of individuals affected and the financial impact of erroneous invoices?
- How does AHIP work with members to expedite resolution of issues for beneficiaries who have been improperly billed for PrEP and related services?
This letter is supported by PrEP4ALL, HIV+Hepatitis Policy Institute, Center for Health and Democracy, and NMAC.
“Unfortunately, one year after CMS and the Department of Labor issued guidance, there are still dozens of documented cases of insurance companies charging patients out-of-pocket for PrEP-related treatment. .” Kenyon Farrow, PrEP4ALL’s Managing Director of Advocacy and Organizing, said: “To end the HIV epidemic, we must ensure that everyone with insurance has access to PrEP services without having to share the cost, as the regulation was intended to do,” said Senator Markley. I applaud Senator Smith for his tireless advocacy on behalf of patients.”
“We thank Senators Markley and Smith for their leadership and wish all colleagues that the Affordable Care Act preventive services provisions are properly implemented. , PrEP drugs and related services must be provided without patient cost sharing.Too many complaints from PrEP users that this does not always occur.The letter urges insurance companies to ensure full compliance. I’m sure you can guarantee that.” Karl Schmidt, Executive Director of the HIV+ Hepatitis Policy Institute, said:
“While appalling, it is sadly unshocking to see a large health plan incorrectly charge its subscribers for medication and ancillary services as part of a PrEP regimen to prevent HIV. do,” Said Wendell Potter, Director of the Center for Health and Democracy. “We thank Senators Markley and Smith for their leadership in sending this letter, highlighting their understanding of the efficacy of PrEP and their compassion for those at risk and their families. did.”
Read the full letter here and below.
Dear Mr. Ailes:
We are writing today about recent reports of patients across the country receiving bills and fees from AHIP members as part of their PrEP regimen for pre-exposure prophylaxis (PrEP) medications that prevent HIV, along with necessary ancillary services. I’m here.[1]Member’s health insurance policyholders may not obtain necessary medicines and ancillary medical care, including medical provider consultation and testing services, contrary to law and additional federal guidance issued by the Departments of Labor, Health, and Human Affairs. I found out that I keep being charged for the service. Service, and Finance. We express our deep concern about these false and unlawful accusations and the steps AHIP is taking to ensure that its members comply with federal law and that the full range of PrEP medications and PrEP ancillary services are provided. Write a letter to request additional information about the action being taken. bill the registrant.
As you know, a 2019 ruling by the United States Preventive Services Task Force (USPSTF) gave PrEP an “A” rating as a preventive intervention for people at risk of HIV infection.[2]Public Health Services Act (PHS Act) Section 2713 requires health insurance issuers that offer non-grandparent group health insurance coverage and non-grandparent group or individual health insurance coverage to provide service coverage. , states that it should not impose a cost-sharing requirement.or an intervention given an “A” or “B” rating by the USPSTF[3].
This statutory requirement for payers remains local law, but the requirement is further clarified in additional federal guidance, including that issued by the Centers for Medicare and Medicaid Services (CMS). [4]In fact, in a July 2021 document issued by CMS, the FDA said, “Programs and issuers should cover PrEP consistent with USPSTF recommendations without sharing costs…” I’m here. CDC) says PrEP is a comprehensive intervention consisting of antiretroviral drugs in addition to basic support services.
Indeed, CMS continues to clarify that PrEP is not just medication, but includes the full range of essential health services associated with PrEP regimens, and explicitly calls for initial clinical evaluation and ongoing monitoring of patients, including HIV testing. Quoted in Hepatitis B and C testing; creatinine testing; sexually transmitted infection (STI) testing and counseling, and other services essential to the effectiveness of PrEP regimens as outlined in the CDC Guidelines for PrEP.
In light of this clear guidance from CMS, we recognize that patients are routinely billed for ongoing, full or cost-sharing practices related to medically appropriate medications and essential services. I am wary of reports. These costs can be daunting. Her HIV advocates and clinicians across the county report that many patients are unaware that they don’t have to pay out-of-pocket for her PrEP and ancillary services. In some cases, these patients may pay more than $1,000 a year when federal law states they should pay nothing. Consumers who attempt to contest these illegal cost-sharing charges on their plans have their claims handed over to collection, causing anxiety and stress, often prompting the individual to discontinue her PrEP. I notice that on a daily basis.
The impact of these costs on patient access and public health generally cannot be underestimated. Multiple academic studies indicate that associated costs (including costs of ancillary services) are barriers to her PrEP access in the United States.[5]despite its incredible effectiveness in reducing the risk of acquiring HIV[6]Inequities in PrEP uptake persist across communities at high risk of HIV, including black and Hispanic communities and transgender women. This is due to limited access to financial resources to cover costs such as PrEP and related medical visits and tests.[7].
While we recognize that partnerships with laboratories and healthcare providers, including accurate billing and coding, can pose challenges, the statutory language of PHSA Section 2713 requires issuers, and only issuers, to It clearly states that the provision of compensation must be legally compliant. For PrEP, including the full range of related services required, without cost sharing. In light of these concerns and role, I request your response to the following questions within 30 days of receipt of this letter.
- To ensure that health care plans comply with federal regulations that clarify the availability of PrEP and ancillary services for patients free of charge, AHIP currently provides what information to support its members. Or do you provide guidance?
- AHIP does not recommend that members provide information or materials to registrants to ensure that patients understand that PrEP, including ancillary services, should be provided to registrants free of charge. what is it?
- How does AHIP work with laboratories and healthcare providers to ensure accurate coding of appointments and services so that registrants are not incorrectly billed for these services?
- How does AHIP work with partners to fully understand the scope of the problem, both in terms of the number of individuals affected and the financial impact of erroneous invoices?
- How does AHIP work with members to expedite resolution of issues for beneficiaries who have been improperly billed for PrEP and related services?
Thank you again for your attention to this pressing issue affecting public health in our country.
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