In response to an investigation by the Maine Bureau of Insurance, Harvard Pilgrim Health Care (also referred to 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 all Harvard Pilgrim Health Care members that purchase insurance through CoverME.gov as well as Harvard Pilgrim members covered under a small employer plan will have access to these drugs.
“I welcome 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,” Bob Carey, Superintendent of Insurance, commented. “I also appreciate the work that health care advocates, in particular 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.
Consumers with questions about insurance matters 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.