CUOMO HEALTH ACTION, from p.6
fall outside of the state’s jurisdiction.
Self-funded plans are largely
governed by federal rather than
state law.
Meanwhile, the administration’s
guide regarding gender-affi rming
care spells out the treatments
insurers must cover and which
insurance plans are required to
cover them. The same insurers required
to cover PrEP without costsharing
must also provide the outlined
gender-affi rming care.
Signifi cantly, employer selffunded
plans cover 5.2 million
New Yorkers compared to the 3.7
million people covered by individual,
small group, and large group
commercial plans, meaning those
who are not covered by the protections
outnumber those who are
covered.
“With these actions, we are removing
a major fi nancial barrier
for people who want to take a
proven HIV prevention drug and
ensuring people have the information
they need at their fi ngertips to
access quality healthcare,” Cuomo
said in a written statement. “These
policies support our nation-leading
campaign to end the AIDS
epidemic in New York by the end of
2020 and ensure every New Yorker
— regardless of sexual orientation
or gender identity — gets the
healthcare protections guaranteed
to them under law.”
The success of the state’s effort
to bring AIDS to an end as an
epidemic will be based largely on
getting those who are HIV-positive
into treatment so they are no longer
infectious while having people
at risk for transmission take
PrEP.
In addition to the robust initiatives
regarding PrEP and genderaffi
rming care, the administration
also proposed a regulation requiring
insurers to provide more relevant
information on healthcare
ID cards such as coverage details,
co-payment costs, and other necessary
information.
Lastly, the administration reminded
New Yorkers that no
matter the actions of the federal
government, the state bans discrimination
on the basis of gender
identity and sexual orientation in
areas including access to health
insurance.
The Cuomo administration’s
moves come amid growing frustration
over the state of health insurance
nationwide, with premiums
growing more expensive while
plans fail to cover some necessary
health services. The Trump administration’s
scaling back of LGBTQ
healthcare protections has
only compounded existing anxieties
surrounding access to care
within the community.
The effort to reign in the cost
of PrEP follows vociferous calls
by HIV/ AIDS advocates and the
wider LGBTQ community to improve
access to a drug that costs
far more in the United States than
in many other parts of the world.
“By requiring that PrEP be covered
without cost-sharing, Governor
Cuomo is allowing more New
Yorkers to take control of their
sexual health, which will save millions
of taxpayer dollars associated
with treating HIV,” said Amida
Care CEO Doug Wirth, whose organization
is a not-for-profi t health
plan that specializes in providing
comprehensive coverage and care
for New Yorkers with HIV, behavioral
health disorders, and other
complex conditions. “Additionally,
arming New Yorkers with vital insurance
information and guaranteeing
that everyone, regardless of
sexual orientation or gender identity,
is protected from discrimination
in healthcare settings will
help remove barriers to healthcare
faced by too many in the LGBTQ
community.”
The Cuomo administration’s
Department of Financial Services
(DFS), which is responsible for
overseeing the insurance industry,
is carrying out much of the
work to implement the changes.
The agency sent a letter to insurers
directing them to cover PrEP,
saying they “must provide coverage
for PrEP for the prevention of
HIV infection at no cost-sharing
and cover screening for HIV infection
at no cost-sharing.” The proposed
rule improving healthcare
ID cards also came through DFS
via a proposed rule.
“We will continue to use our full
authority to push back against
federal efforts to roll back coverage
and ensure that New Yorkers receive
the healthcare they deserve
without discrimination, regardless
of sexual orientation, gender identity
or expression,” DFS superintendent
Linda Lacewell said.
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