May 2, 2019

Correction on Last Week’s Copay Accumulator Program Article

Last week’s Public Policy column stated that “Medicare and Medicaid recipients will be able to purchase the prescribed drug and use a copay coupon… without concern that the value of the coupon will not be applied to her or his deductible” if no generic version of the prescribed drug was available. We have since learned that this victory applied to everyone, not just to Medicare and Medicaid recipients. It is clearly stated in the Federal Register under the “Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2020, page 92”. Apologies for the error and GOOD NEWS!! 

Update to AAHIVM Position Statement on Harm Reduction

On May 1, the Academy’s Board of Directors approved an addition to our Position Statement on Harm Reduction. The original statement supports Needle and Syringe Exchange programs as tools for reducing HIV transmission among people who use drugs.

In its March meeting, the Public Policy Committee recommended that we expand this statement to include support for the establishment of Supervised Consumption Services (SCS), another proven strategy for reducing HIV and HCV transmission among people using injected drugs. Several cities, including San Francisco, Seattle, Philadelphia and New York, are currently undergoing intense debates over legalizing this approach.

The Committee — after discussing and approving their added language in support of SCS — forwarded the revised Policy Statement to the Executive Committee for its consideration. It received EC approval on April 3 and now awaits the verdict of the full Board in June. If accepted, the amended statement will be available online here (see page 45).

Debate Drags on re: Legitimacy of Association Health Plans

In a recent op ed published in The Hill, financial expert Gene Marks opposed the Administration’s support for Association Health Plans (AHP) on the ground that they are “just too risky.” AHPs are entities created by small businesses who join together to offer large group insurance coverage, instead of individual small group plans.

The AHP structure, Marks notes, does not have Congressional approval as the ACA does. It was simply “ordered by the president, written up by his [Department of Labor] and then signed into existence by his Secretary of Labor.”

These views echo those of U.S. District Judge John Bates who, last March, struck down a Department of Labor ruling allowing AHPs, on the grounds that it defines “‘employer’ to include associations of disparate employers.” He further asserted that “expanding membership in these associations to include working owners without employees are unlawful and must be set aside.”

Bates’ opinion added that AHPs were “clearly an end-run” around consumer protections required by the Obama-era Affordable Care Act and described them as doing violence to the Employee Retirement Income Security Act of 1974, the framework for employer-sponsored health plans covering tens of millions of Americans.

Some Republican senators oppose the ruling and regard AHPs —like Short Term Limited Duration (STLD) insurance plans — as necessary, low cost alternatives to the ACA. On April 15, Senators Chuck Grassley and Joni Ernst (both R-IA), Mike Enzi (R-WY) and colleagues introduced legislation that will, according to their press release, “ensure the new pathway remains available for small businesses to offer Association Health Plans under the Department of Labor’s final rule.”

The progress of Grassley’s bill will, presumably, determine the next step in this debate.

View the latest Policy Update here.