Van Hollen, Merkley, Smith, anzawo amalira alamu pa milandu yoletsedwa kwa odwala PrEP

08 September 2022

Mamembala a AHIP anena kuti akulipiritsa odwala mankhwala osokoneza bongo ndi zina zowonjezera kuti apewe kutenga kachilombo ka HIV

Lero, Senator waku US Chris Van Hollen (D-MD) adalumikizana ndi Senators Jeff Merkley (Raw Democrat) ndi Tina Smith (D-Minnesota) pamodzi ndi Senators Elizabeth Warren (D-Mass.), ndi Bernie Sanders (i-Vatto). ), Tammy Baldwin (D-Wis.), Edward J. Markey (D-Mass.), ndi Cory Booker (DNJ) m’kalata yopita kwa AHIP, bungwe lazamalonda loimira makampani a inshuwaransi yazaumoyo. Kalatayo ikufotokoza zodetsa nkhawa za kupitiliza kwa mchitidwe wolipiritsa anthu ndalama mosaloledwa pa pre-exposure prophylaxis (PrEP) ndi chisamaliro chofananira.

Kalata ya maseneta ikubwera pambuyo pa chigamulo cha khothi Lachitatu chomwe chikuwopseza mwayi wopeza PrEP. Pamene ndondomeko yalamulo inkapitirira, maseneta adakakamiza makampani a inshuwalansi ya umoyo kuti azitsatira malamulo omwe analipo kuti apereke mankhwala ndi ntchito zothandizira popanda malipiro.

“Zadziwitsidwa kwa ife kuti omwe akulembetsa m’mapulani azaumoyo a mamembala anu akupitilizabe kulipiritsa ndalama zothandizira mankhwala ofunikira ndi chithandizo chothandizira – kuphatikiza upangiri wopereka upangiri ndi maupangiri a labotale – motsutsana ndi malamulo ndi malangizo owonjezera aboma operekedwa ndi dipatimenti ya Labor, Health, Human. Services, ndi Treasury. ” Mabuku Akuluakulu. “Tikukulemberani kuti tifotokozere nkhawa zathu zamilandu yolakwika komanso yosagwirizana ndi malamulowa, komanso kupempha zambiri za zomwe AHIP ikuchita kuti zitsimikizire kuti mamembala ake akutsatira malamulo aboma ndikuwonetsetsa kuti mankhwala a PrEP ndi zina zambiri. Ntchito za PrEP zimaperekedwa kwaulere kwa olembetsa. ”

Chigamulo cha 2019 cha US Preventive Services Task Force (USPSTF) chidapatsa PrEP “A” ngati njira yopewera anthu omwe ali pachiwopsezo chotenga kachilombo ka HIV. Izi zidabweretsa PrEP pansi pa Gawo 2713 la Public Health Services Act, lomwe limafunikira inshuwaransi pazantchito kapena njira zomwe zapatsidwa “A” kapena “B” kuchokera ku USPSTF.

Malangizo otsatira, ofalitsidwa ndi Centers for Medicare and Medicaid Services (CMS) mu Julayi 2021, adafotokoza bwino chigamulo chawo. Powona kuti “mapulani ndi ogulitsa kunja ayenera kuphimba PrEP mogwirizana ndi ndondomeko ya USPSTF popanda kugawana ndalama,” chigamulocho chikupitiriza kufotokoza momveka bwino kuti PrEP si mankhwala okha, koma ntchito zonse zofunikira zokhudzana ndi zomwe zikuphatikizapo kuyesa, kufufuza, ndi maulendo opereka chithandizo. Ngakhale chigamulochi ndi kufotokozera motsatira, anthu amalipira molakwika ndalama zomwe amawononga zokhudzana ndi chisamaliro chawo cha PrEP.

“Potsatira malangizo omveka bwinowa ochokera ku CMS, tikukhudzidwa ndi malipoti osalekeza akuti odwala amalipidwa nthawi zonse, kaya ndi malipiro athunthu kapena machitidwe ogawana ndalama, okhudzana ndi mankhwala ndi mautumiki oyenera achipatala,” adatero. Pitiliranibe. Olimbikitsa HIV ndi ogwira ntchito zachipatala m’chigawo chonsecho adanena kuti odwala ambiri sazindikira kuti sakuyenera kulipira m’thumba kuti apereke PrEP ndi zina, poganiza kuti zambiri mwazinthuzi ndizofunikira kuti apeze PrEP. ”

Kalata ya maseneta ikuwonetsa kusagwirizana pakulandila kwa PrEP m’madera omwe ali pachiwopsezo chachikulu chotenga kachilombo ka HIV-kuphatikiza madera akuda, Puerto Rico ndi azimayi osinthika – chifukwa cholephera kupeza ndalama zolipirira mtengo wa PrEP, kupita kuchipatala, ndi kuyezetsa magazi. Zogwirizana ndi, mwa zina.

Potengera izi, opanga malamulo akufunsa mafunso otsatirawa ndikupempha yankho kuchokera ku AHIP mkati mwa masiku 30:

  1. Ndi chidziwitso kapena chitsogozo chotani chomwe AHIP ikupereka pakadali pano kuthandiza mamembala ake kuwonetsetsa kuti mapulani awo azaumoyo akutsatira malamulo aboma omwe amamveketsa bwino kuti PrEP ndi chithandizo chowonjezera chiyenera kupezeka kwa odwala kwaulere?
  2. Ndi zidziwitso ndi zida zotani zophunzitsira zomwe AHIP imalimbikitsa kuti mamembala ake azipereka kwa olembetsa kuti awonetsetse kuti odwala akudziwa kuti PrEP, kuphatikiza mautumiki owonjezera, ayenera kupezeka popanda mtengo kwa olembetsa?
  3. Kodi AHIP imagwira ntchito bwanji ndi ma laboratories ndi othandizira azaumoyo kuti awonetsetse kuti nthawi yoikidwiratu ndi ntchito zalembedwa molondola kuti olembetsa asamalipitsidwe molakwika pazithandizozi?
  4. Kodi AHIP imagwira ntchito bwanji ndi ogwirizana nawo kuti amvetsetse kukula kwa vutoli, potengera kuchuluka kwa anthu omwe akhudzidwa komanso mavuto azachuma chifukwa cholipira molakwika?
  5. Kodi AHIP imagwira ntchito bwanji ndi mamembala ake kuti athetse mwachangu nkhani za opindula omwe amalipiritsidwa molakwika pa PrEP ndi ntchito zina?

Kalatayo imathandizidwa ndi PrEP4ALL, HIV+ Hepatitis Policy Institute, Center for Health and Democracy, ndi NMAC.

“Tsoka ilo, talembapo milandu yambirimbiri yamakampani a inshuwaransi omwe amalipiritsabe odwala m’thumba kuti alandire chisamaliro chokhudzana ndi PrEP, patatha chaka CMS ndi dipatimenti yazantchito zidapereka malangizo awo,” adatero. Kenyon Farrow, Managing Director of Advocacy and Regulation pa PrEP4ALL. “Kuthetsa mliri wa HIV kumafuna kuti tiwonetsetse kuti aliyense amene ali ndi inshuwalansi atha kupeza chithandizo cha PrEP popanda kugawana ndalama, monga momwe zimakhalira nthawi zonse.”

“Tikuthokoza utsogoleri wa Senators Merkley ndi Smith ndi onse ogwira nawo ntchito omwe akufuna kuwonetsetsa kuti ntchito zodzitetezera za Affordable Care Act zikutsatiridwa bwino.” Ma inshuwaransi payekha ayenera kupereka mankhwala a PrEP ndi ntchito zina popanda ndalama zogawana odwala. Timalandira madandaulo ambiri. Tili ndi chidaliro kuti makampani a inshuwaransi atsatiradi uthengawu mokwanira. adatero Carl Schmid, mkulu wa bungwe la HIV+ Hepatitis Policy Institute.

“Ngakhale ndizodabwitsa, sizodabwitsa kuwona Big Health Inshuwalansi ikulipira molakwika anthu olembetsa mankhwala ndi ntchito zina monga gawo la dongosolo la PrEP la kupewa HIV, ngakhale malangizo omveka bwino ochokera ku Dipatimenti ya Zaumoyo ndi Zaumoyo ndi Ntchito ndi Treasury kuchita izo,” Iye anatero Wendell Potter, Purezidenti wa Center for Health and Democracy. “Ndife othokoza chifukwa cha utsogoleri wa Senators Merkley ndi Smith potumiza uthengawu, kuti titsimikize kumvetsetsa kwawo kwa mphamvu ya PrEP ndi chifundo chawo kwa omwe ali pachiopsezo ndi mabanja awo.”

Mawu onse a uthengawo akupezeka apa motere:

Wokondedwa Bambo Ailes

Lero tikulemba zokhudza malipoti aposachedwa a odwala m’dziko lonselo akulandira mabilu ndi chindapusa kuchokera kwa mamembala a AHIP a mankhwala a pre-exposure prophylaxis (PrEP) omwe amateteza kachilombo ka HIV, pamodzi ndi ntchito zina zofunika, monga gawo la dongosolo la PrEP. Zadziwitsidwa kuti olembetsa mu mapulani azaumoyo akupitilizabe kulipiritsa mamembala anu kuti alandire mankhwala ofunikira ndi mautumiki owonjezera – kuphatikiza upangiri wopereka upangiri ndi mautumiki a labotale – mosiyana ndi malamulo ndi malangizo owonjezera aboma operekedwa ndi Madipatimenti a Ntchito, Zaumoyo, Zothandizira Anthu, ndi Treasury. Tikulemba kuti tifotokoze nkhawa zathu za milandu yolakwika ndi yosaloledwa, komanso kupempha zambiri za njira zomwe AHIP ikuchita pofuna kuwonetsetsa kuti mamembala ake akutsatira malamulo a federal komanso kuwonetsetsa kuti mankhwala a PrEP komanso kuchuluka kwa ntchito zina za PrEP zikuperekedwa. opanda udindo kwa olembetsa.

Monga mukudziwira, chigamulo cha 2019 cha United States Preventive Services Task Force (USPSTF) chinapatsa PrEP “A” ngati njira yopewera anthu omwe ali pachiwopsezo chachikulu chotenga kachilombo ka HIV. Ndime 2713 ya Public Health Services Act (PHS Act) imati mapulani azaumoyo amagulu omwe sali eni eni ndi omwe amapereka inshuwaransi yaumoyo omwe amapereka inshuwaransi yamagulu kapena munthu aliyense payekha ayenera kupereka chithandizo, ndipo sayenera kukakamiza kugawana mtengo. kapena kulowererapo adavotera “A” kapena “B” ndi USPSTF.

Ngakhale kuti lamulo lalamulo kwa olipira lidakali lamulo ladziko, lamuloli lafotokozedwanso m’mawu owonjezera a federal, kuphatikizapo omwe aperekedwa ndi Centers for Medicare and Medicaid Services (CMS). Zowonadi, mu chikalata cha Julayi 2021 chofalitsidwa ndi CMS, bungweli lidazindikira kuti “mapulani ndi ogulitsa kunja akuyenera kubisa PrEP mogwirizana ndi malingaliro a USPSTF osagawana mtengo …” CDC) , kusonyeza kuti PrEP ndi njira yopititsira patsogolo yopangidwa ndi mankhwala ochepetsa mphamvu ya kachilombo ka HIV kuwonjezera pa chithandizo chofunikira.

Zoonadi, CMS inapitiriza kufotokoza kuti PrEP si mankhwala chabe, koma imaphatikizapo chithandizo chonse chamankhwala chofunikira chokhudzana ndi ndondomeko ya PrEP, kufotokoza momveka bwino kuwunika koyambirira kwachipatala ndi kuyang’anira kosalekeza kwa odwala kuphatikizapo kuyezetsa HIV; Kuyeza kwa chiwindi B ndi C; Kuyeza kwa Creatinine kuyezetsa matenda opatsirana pogonana (STI) ndi uphungu, ndi ntchito zina zofunika kuti ndondomeko ya PrEP ikhale yogwira mtima monga momwe CDC Guidelines for PrEP yafotokozera.

Chifukwa cha malangizo omveka bwinowa ochokera ku CMS, tikukhudzidwa ndi malipoti osalekeza akuti odwala amalipidwa nthawi zonse, kaya ndi malipiro athunthu kapena machitidwe ogawana ndalama, okhudzana ndi mankhwala oyenera achipatala ndi ntchito zofunika. Ndalama zimenezi zingakhale zovuta. Othandizira za kachilombo ka HIV ndi ogwira ntchito zachipatala m’chigawo chonsecho akuti odwala ambiri sazindikira kuti sakuyenera kulipira m’thumba kuti apeze PrEP ndi zina zowonjezera, poganiza kuti zambiri mwazinthuzi ndizofunikira kuti apeze mankhwala a PrEP. Nthawi zina, odwalawa amatha kulipira ndalama zoposa $1,000 pachaka pamene malamulo a boma safuna kulipira kalikonse. Ogula omwe amayesa kutsutsa ndalama zogawana ndalama zosaloledwa ndi ndondomeko zawo nthawi zonse amapeza kuti zonena zimayikidwa m’magulu, zomwe zimayambitsa nkhawa ndi nkhawa, ndipo nthawi zambiri, zimapangitsa anthu kusiya kugwiritsa ntchito PrEP.

Zotsatira za ndalamazi pakupeza odwala komanso thanzi labwino silingathe kuchepetsedwa. Kafukufuku wambiri wamaphunziro awonetsa kuti ndalama zomwe zimagwirizana – kuphatikiza mtengo wa mautumiki owonjezera – zikuyimira cholepheretsa kupeza PrEP ku United States, ngakhale kuti ndi kothandiza kwambiri pochepetsa chiopsezo chotenga kachilombo ka HIV. Kusalinganika pakulandila PrEP kukupitilirabe m’madera omwe ali pachiwopsezo chachikulu chotenga kachilombo ka HIV – kuphatikiza azimayi akuda, a ku Spain ndi omwe alibe – chifukwa chosowa ndalama zolipirira mtengo wa PrEP komanso kupita kuchipatala ndi kuyezetsa ma labu, mwa zina.

Ngakhale tikuzindikira kuti mgwirizano ndi ma laboratories ndi opereka chithandizo chamankhwala, kuphatikiza mabilu ang’onoang’ono ndi zolemba, zingayambitse zovuta, chilankhulo chalamulo cha PHSA Gawo 2713 chikuwonekera bwino pozindikira kuti ogulitsa ndi otumiza kunja okha ndi omwe amafunikira mwalamulo kuti azitsatira zoperekedwa ndi PrEP, kuphatikiza. ntchito zosiyanasiyana zofunika Zoyenera, popanda kugawana mtengo. Potengera madandaulowa, ndi udindo wathu kufunsa mayankho a mafunso otsatirawa pasanathe masiku 30 kuchokera pamene talandira kalatayi:

  1. Ndi chidziwitso kapena chitsogozo chotani chomwe AHIP ikupereka pakadali pano kuthandiza mamembala ake kuwonetsetsa kuti mapulani awo azaumoyo akutsatira malamulo aboma omwe amamveketsa bwino kuti PrEP ndi chithandizo chowonjezera chiyenera kupezeka kwa odwala kwaulere?
  2. Ndi zidziwitso ndi zida zotani zophunzitsira zomwe AHIP imalimbikitsa kuti mamembala ake azipereka kwa olembetsa kuti awonetsetse kuti odwala akudziwa kuti PrEP, kuphatikiza mautumiki owonjezera, ayenera kupezeka popanda mtengo kwa olembetsa?
  3. Kodi AHIP imagwira ntchito bwanji ndi ma laboratories ndi othandizira azaumoyo kuti awonetsetse kuti nthawi yoikidwiratu ndi ntchito zalembedwa molondola kuti olembetsa asamalipitsidwe molakwika pazithandizozi?
  4. Kodi AHIP imagwira ntchito bwanji ndi anzawo kuti amvetsetse kukula kwa vutolo, potengera kuchuluka kwa anthu omwe akhudzidwa komanso mavuto azachuma chifukwa cholipira molakwika?
  5. Kodi AHIP imagwira ntchito bwanji ndi mamembala ake kuti athetse mwachangu nkhani za opindula omwe amalipiritsidwa molakwika pa PrEP ndi ntchito zina?

Tikuthokozanso chifukwa cha chidwi chanu pankhaniyi yomwe ikukhudza thanzi la anthu mdziko lathu.

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