National Coalition for LGBT Health Advocacy Brief – November 26, 2019

Proposed Rule Would Gut Nondiscrimination Requirements for HHS Grants

Removes explicit nondiscrimination protections on multiple bases and rejects the Supreme Court’s establishment of marriage equality as the law of the land

The Trump Administration is planning to release a rule that would allow any program receiving Department of Health and Human Services (HHS) funding – including HIV/AIDS prevention, treatment and support services, and community health centers – to discriminate based on sex, sexual orientation, gender identity, or religion in the provision of services.  The proposed rule, which is a reversal of Obama-era HHS grant regulations, strips away civil rights and patient privacy in order to expand religious exemptions, promulgate rules that severely restrict access to reproductive health care, and undermine strong nondiscrimination protections established under the Affordable Care Act. The Administration has defended its decision by saying that, under the proposed rule, HHS grant-funding would require that programs not discriminate against those seeking their services “to the extent doing so is prohibited by federal statute.” There are currently no explicit statutory protections concerning sexual orientation or gender identity.

Read more from the Center for American Progress.

Read more from AIDS United.

Open Enrollment – Sign-up for an ACA Health Plan Now Through Dec. 15

LGBTQ adults are more likely to experience financial distress than heterosexual adults in the US. Health insurance plans available on the marketplace created under the Affordable Care Act (ACA) offer income-based financial subsidies to reduce premium costs.  To make sure you have health insurance for 2020, you have to enroll between November 1, 2019 and December 15, 2019. If you miss the December 15th deadline you could be locked out of the health insurance marketplace until 2021, and forced to pay 100% of your medical bills out-of-pocket. It’s not worth the risk, especially when financial help is available, so most people can find a plan for $50 to $100 per month.

In past years, the enrollment period was much longer, but the Trump Administration is making every effort to sabotage the Affordable Care Act and has cut the enrollment period in half. That means it’s more important than ever for you, your family, and your friends to know about the new deadline and your rights when it comes to health insurance and health care access.

ACTION: Enroll Today!

ACTION: Distribute Out2Enroll information to your community.

Junk Health Insurance Plans – Don’t Get Fooled!

Don’t get fooled into purchasing a skimpier health care plan that does not meet the standards of the Affordable Care Act (ACA). The Trump Administration has expanded access to short-term, limited-duration health insurance plans that can last up to one year. These plans may discriminate based on pre-existing conditions, and often don’t cover basic services such as mental health care, maternity care, cancer treatment, and prescription drug coverage. Additionally, with certain changes in health status, such as pregnancy or an injury from an accident, you may be denied coverage or dropped from your plan. If you are shopping for insurance on your state’s marketplace, stick to HealthCare.gov, which contains only plans that meet ACA patient protection standards.

Step-Therapy and How it Hurts Patients

Step therapy, or “fail first”/skip therapy, is a process used by health insurers to control costs by allowing insurance companies to specify the medication a patient must try first, instead of the patient’s health care provider. The medications selected by the insurance company are typically older, generic or low-cost medications that may not be the most advanced to treat the patient’s condition. The patient must try these medications and have their symptoms fail to improve before they are allowed to “step-up” to another medication that may be more expensive for the insurer. This practice can harm patients who switch insurers while being treated for a chronic condition by forcing them to switch off their current medication to a medication that may not work as well. Additionally, newer medications with less side effects or combination therapies (two or more medications in a single tablet) may not be readily available to patients whose insurers practice step therapy.

ACTION: Check your prescription drug coverage annually to ensure your medications are covered.

Watch Out for Misleading Ads About Truvada Class-Action Lawsuit

Individuals taking or interested in accessing PrEP (pre-exposure prophylaxis), the medication that prevents HIV in HIV negative individuals, are being bombarded by misleading social media and television advertisements about a class-action lawsuit against the makers of the drug emtricitabine/tenofovir disoproxil fumarate (Truvada). These ads contain inflammatory and frightening language, such as warnings about “Life-Threatening Side Effects,” that are causing people not to start or to stop taking PrEP.

In reality, the lawsuit at the heart of these ads is mainly focused on individuals using Truvada for the long-term treatment of HIV, not those using Truvada for PrEP (the drug may be used for both prevention and treatment of HIV). The suit is based on the allegation that Gilead, the company that manufactures Truvada, withheld the release of emtricitabine/tenofovir alafenamide (Descovy) for PrEP, a new drug with statistically fewer bone and kidney side effects in clinical studies, in order to maximize sales of Truvada. Nevertheless, Truvada for PrEP is extremely safe, and is supported by the scientific and public health community.

Truvada is a medication approved by the U.S. Food and Drug Administration (FDA) for use both as HIV preexposure prophylaxis (PrEP) and treatment of HIV. The FDA Drug Approval Package can be found here. Based on its review of the evidence, the US  Preventative Services Task Force issued a Grade A recommendation (meaning there is high certainty that the net benefit is substantial) that clinicians offer Truvada as PrEP to persons who are at high risk of HIV acquisition. The evidence summary supporting this recommendation can be found here. PrEP is a critical component of the national plan to end the HIV epidemic in the US by 2030, and the first biomedical intervention to prevent HIV.

Read more from the New York Department of Health.

Read more from TheBodyPro.com.

Interested in starting PrEP or learning more? Check out the PrEP Facts Facebook page.

Medicare Open Enrollment – Getting Your Drug Coverage Right

Medicare open enrollment closes Dec. 7

We are in the Medicare open enrollment period.  Medicare’s annual open enrollment period closes December 7, 2019 with changes in coverage taking effect January 1, 2020. Now is the time to change plans to get the most out of our drug coverage in 2020. Each year, plans add or drop coverage of certain drugs. Plans may also change cost-sharing aspects such as deductibles (the standard Medicare deductible will be $435 in 2020), co-insurance (the 2020 standard will be 25%), and co-pays.

In 2020, the average Medicare beneficiary will have a choice between twenty-eight prescription drug plans with premiums ranging from $13 to $83 per month. Beneficiaries who qualify for the Low-Income Subsidy will have a choice of an average of seven prescription drug plans. Review your plan now to avoid costly surprises later. Check to see if your medications are covered in your new plan, and assess the cost-sharing options of the plan (deductibles, co-pays, co-insurance). Don’t add or drop a Medicare supplemental plan — aka Medigap — until you understand the separate rules that may apply to those policies.

Are you newly eligible for Medicare? Remember, prescription drug coverage is an optional supplement to standard Medicare coverage. Those who do not initially opt in to prescription coverage may pay a life-long penalty if they choose to add prescription drug coverage later on.

Read more from the Kaiser Family Foundation.

Tips for getting your Medicare drug coverage right from CNBC.

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