Statement from Paul Macielak, HPA President & CEO
“For several weeks the New York Health Plan Association (HPA) and its member plans have been talking with regulatory agencies and the Attorney General’s office, seeking an approach to be applied prospectively that reflects evolving clinical standards to ensure patients have access to hepatitis C drug treatment while allowing plans to utilize evidence-based guidance in their coverage criteria. For the Attorney General to now turn around and pursue legal action against a health plan undercuts this effort.
“As newer drugs come on the market, clinical guidance issued by government and professional societies continues to advance, and plan coverage policies are reviewed by state agencies with various appeal processes to insure consumers get appropriate services. The AG’s assertion that health plan coverage criteria, which are clinically based, balanced and comparable to — if not more generous than — what many state governments have adopted, somehow ‘illegally restrict’ treatment is wrong on the merits and, more importantly, ignores the role of existing processes to perform ongoing review and revision of coverage criteria.
“Moreover, focusing on plans’ coverage criteria overall is misplaced given the exorbitant cost of these drugs that continue driving up the cost of pharmacy benefits, increasing the overall cost of health insurance to hundreds of thousands of individual New York families and businesses. The AG’s efforts would be better spent taking a more aggressive position on the excessive pricing of these hepatitis C drugs, which would produce genuine benefits for New Yorkers.”