MAINE, USA — We have an update on a story about Harvard Pilgrim Health Care offering plans in 2025 that do not cover several leading HIV medications.
The Maine Bureau of Insurance announced Monday that the carrier reversed its initial decision and will cover eight HIV regimens in 2025, including Bictarvy, the most widely prescribed HIV treatment in the US.
This decision will impact about 100 Harvard Pilgrim Health Care plan members and is in response to an investigation by state insurance officials into a complaint claiming the carrier's plans discriminate against Mainers living with HIV.
The change will mean all Havard Pilgrim Health Care members who purchase insurance through CoverME.gov and Harvard Pilgrim members who are covered under a small employer plan will have access to these drugs.
Katie Rutherford is the Executive Director of the Frannie Peabody Center, which provides services and resources to Mainers living with HIV.
"This is a bigger issue as far as medication coverage and affordable health care are concerned, and it's vital that we continue to advocate for adequate care for people experiencing chronic conditions," Rutherford explained.
"In response to an investigation by the Maine Bureau of Insurance, Harvard Pilgrim Health Care (also known as Point32 Health) has agreed to continue covering Biktarvy and other HIV medications on the prescription drug formulary offered to Maine consumers. The change will mean that all Harvard Pilgrim Health Care members who purchase insurance through CoverME.gov and those covered under a small employer plan will have access to these drugs," Bob Carey, Superintendent of the Maine Bureau of Insurance said in a statement.
"I welcome the action taken by Harvard Pilgrim to reverse its initial decision to exclude these drugs — a decision made after the Bureau of Insurance pushed for this change," Carey commented. "I also appreciate the work that health care advocates, particularly the HIV + Hepatitis Policy Institute, and health care providers played in bringing this matter to our attention."
In addition to covering Biktarvy on the drug formulary, Harvard Pilgrim will cover all eight preferred and alternative regimens for the treatment of HIV, as recommended under national treatment guidelines.
"The Bureau of Insurance will make certain that people with HIV — or any other condition — are not unfairly discriminated against or forced to switch insurers to maintain their course of treatment," Carey noted. As a result of the Bureau's intervention, all insurers offering coverage on CoverMe.gov will cover Biktarvy on their 2025 drug formulary," Carey said.
Consumers with insurance questions can obtain information and assistance from the Maine Bureau of Insurance by visiting www.maine.gov/insurance, calling 800-300-5000 (TTY: call Maine Relay 711), or e-mailing Insurance.PFR@maine.gov.
