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Recently, you may have read about Harvard Pilgrim Health Care’s initial decision not to cover several HIV antiretroviral medications for Mainers purchasing their health insurance through CoverME.gov or individuals covered under a small employer plan.
Of the two medications, Biktarvy is the most commonly prescribed treatment regimen in the United States and is currently prescribed to nearly 50 percent of people living with HIV. The decision not to cover the medication would have impacted more than 100 individuals in the state of Maine.
Last month, we joined physicians, health care experts from across the state, and national advocacy partners in urging the Maine Bureau of Insurance to work with Harvard Pilgrim and ensure coverage is in line with HIV treatment guidelines and compliant with all Affordable Care Act coverage requirements.
Following pressure from the bureau, Harvard Pilgrim reversed its initial decision and confirmed it will cover this HIV treatment in 2025. We applaud the efforts that led to this decision and thank Superintendent of Insurance Bob Carey for stepping in to ensure continued access to these life-saving medications for people in Maine. Outcomes are still unclear for similar complaints filed in two other states, however, emphasizing the fragility of these systems.
This issue highlights a broader concern regarding medication coverage and affordable health care. It underscores the critical need to continue advocating for equitable access to comprehensive care for individuals managing chronic conditions.
As executive director of the state’s largest and leading nonprofit organization providing HIV/AIDS services, Frannie Peabody Center, we serve more than 400 Mainers living with HIV/AIDS and distribute more than 1,000 HIV tests annually. At our core, we provide integrated care through case management, housing, and financial assistance for those living with HIV/AIDS.
As a community, we must remain committed to ensuring that individuals are provided affordable and comprehensive health care to live healthy, fulfilling lives.
Katie Rutherford
Executive director
Frannie Peabody Center
Portland