Access to affordable, comprehensive health care for those in the Deferred Action for Childhood Arrivals (DACA) program is still available under the Affordable Care Act through Health Insurance Marketplaces nationwide, including Pennie. Enrolling in coverage is not considered a public charge determination and should have no impact on DACA recipient’s current status. There have not been any policy changes to date and enrollment assisters should continue to assist all those who do not qualify for Medicaid, Medicare or other coverages to preview options through Pennie by Dec. 15 for coverage to begin Jan. 1. The first initial premium payment must be made by Dec. 31 for policies to be made active.

In 2023, the Pennsylvania Insurance Department partnered with Texas A&M University and the Robert Wood Johnson Foundation to study barriers to accessing healthcare. The study found that only 13% of the provider listings had accurate contact information, and up to 44% of providers were unreachable because of incorrect information. The most common inaccuracies involved outdated contact information and incorrect specialty listings, which could mislead patients and lead to care delays and unexpected charges. The secret shopper survey of almost 7,000 providers listed in provider directories for Pennsylvania’s ACA Marketplace plans indicates that inaccuracies often persist for long periods of time and beyond the requirements set by recent federal law.

The Advisory Commission on Additional Licensing Models has released draft preliminary recommendations for public comment. The recommendations are intended for state medical boards, state legislators, policymakers, and interested stakeholders to help inform those jurisdictions interested in developing or modifying additional licensing pathways for physicians who have completed training internationally. The Advisory Commission compiled the draft preliminary recommendations in response to a growing number of U.S. state and territorial legislatures interested in modifying traditional post-graduate training requirements for medical licensure of physicians who have completed training internationally by eliminating the traditional requirement for completion of ACGME-accredited graduate medical education in the U.S. All interested parties should submit comments about the draft recommendations by Dec. 6, 2024.

The Jewish Healthcare Foundation and Health Career Futures are proud to announce the 2025 Death and Dying Fellowship. Over the course of nine sessions, fellows will learn critical skills and concepts in serious illness care as part of a multidisciplinary group. The program features opportunities to engage with experts, participate in site visits, and practice conversation skills in a low-pressure environment.

The Substance Abuse and Mental health Services Administration (SAMHSA) released the 2023 National Survey on Drug Use and Health results, including two infographics highlighting overall findings and findings by race and ethnicity. The data showed that in the past year, 23% of adults had a mental illness, 3% of people misused opioids, and 32% of adolescents received mental health treatment. Visit SAMHSA’s website for the data, infographics, and more.

Drugmaker Eli Lilly revealed that it had planned to impose a 340B rebate model on all covered entities (including CHCs) for all Lilly drugs, effective in Nov., and had communicated their plans to HRSA over the summer. However, after HRSA threatened to remove Johnson & Johnson’s access to the Medicaid and Medicare Part B markets if they implemented their own limited 340B rebate model, Lilly decided to put its rebate plans on-hold. Eli Lilly’s plans became public when they filed a lawsuit against HRSA, claiming that the agency exceeded its authority by seeking to block the rebate model. A similar suit was filed two days earlier by J&J. Lilly was the first manufacturer to impose contract pharmacy restrictions, so it is not surprising that they would seek to be an “early adopter” of a rebate model. While both lawsuits name the current HHS Secretary and HRSA Administrator as defendants, these individuals will soon be replaced by Trump appointees. Currently, there is no reliable information about how the Trump Administration will respond to the drugmakers’ arguments.

World AIDS Day announcement showcases HRSA’s historic success in advancing HIV care nationwide

In commemoration of World AIDS Day, the Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services (HHS), announced a record-breaking 90.6 percent of people with HIV receiving medical care through the Ryan White HIV/AIDS Program are virally suppressed, exceeding national viral suppression rates. Viral suppression means people with HIV taking their medication cannot sexually transmit HIV and can live longer and healthier lives.

HRSA Administrator Carole Johnson, joined by White House Office of National AIDS Policy Director Francisco Ruiz and HIV community leaders, announced these latest data at a World AIDS Day community event at La Clínica del Pueblo in Northwest Washington, D.C. This milestone highlights the Ryan White HIV/AIDS Program’s vital role in expanding access to care for individuals with HIV, improving health outcomes, and contributing to ending the HIV epidemic in the United States.

“At the Health Resources and Services Administration, the care and treatment we have continuously supported through our Ryan White HIV/AIDS Program over the last 34 years is making it possible for hundreds of thousands of people with HIV to live long, healthy lives,” said HRSA Administrator Carole Johnson. “Today’s record-breaking data highlight the impact of the Ryan White Program and underscore the vital role of the program to ensure no communities are left behind as we work towards ending the HIV epidemic.”

HRSA’s Ryan White HIV/AIDS Program provides a comprehensive system of HIV primary medical care, medication, and support services to more than half of people with diagnosed HIV in the United States each year. The program tailors approaches to best meet the needs of individual people with HIV and their communities, including by addressing health-related needs like housing, transportation, medical case management, mental and behavioral health care, and food access that directly affect the ability of patients to enter and stay in care and access treatment services. The federal Ending the HIV Epidemic in the U.S. (EHE) initiative expands upon the vital work of the Ryan White HIV/AIDS Program to reach people newly diagnosed with HIV and people with HIV out of care by enhancing linkage to and engagement in care, decreasing disparities, and improving viral suppression.

The new Ryan White HIV/AIDS Program data reflect several key milestones:

• More than 576,000 people with HIV in the U.S. received life-saving care, medication, and essential support services through the Ryan White HIV/AIDS Program, representing over 50% of those with diagnosed HIV in the U.S.
• Nearly 91 percent of Ryan White HIV/AIDS Program clients receiving HIV medical care were virally suppressed in 2023. This is up from 70 percent of clients virally suppressed in 2010 and significantly higher than the 65 percent virally suppressed nationally (which includes people who do not qualify or receive treatment through the Ryan White Program).
• Nearly 48 percent of Ryan White HIV/AIDS Program clients are aged 50 years and older, demonstrating the program’s success in supporting older clients and its commitment to addressing the unique needs of people with HIV as they age.

The Ryan White HIV/AIDS Program supports recipients that address the epidemic in communities most severely affected by HIV, including cities and counties (Part A); states and territories (Part B); local community-based groups that provide ambulatory health services for people with HIV (Part C); local community-based groups that provide medical care for low-income women, infants, children and youth with HIV (Part D); and for HIV workforce education and training, oral health care, and other innovative models of HIV care and treatment (Part F).

To access the new 2023 Ryan White HIV/AIDS Program By the Numbers data infographic, visit: https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/resources/rwhap-hrsa-numbers-2023.pdf (PDF – 871 KB).

To learn more about HRSA’s Ryan White HIV/AIDS Program, visit ryanwhite.hrsa.gov.

For more information about HRSA’s role in the Ending the HIV Epidemic in the U.S. initiative, visit www.hrsa.gov/ending-HIV-epidemic.

Beginning in 2025, all Medicare plans will include a yearly $2,000 cap on covered out-of-pocket prescription drug costs. The cap only applies to drugs that are covered by their Medicare plan, making it especially important for those with Medicare to review their plan to make sure their specific drugs are covered. If people with Medicare have prescription drugs that are not covered by the plan they choose, they will not be able to fully benefit from the cap.

Plan Finder provides an opportunity to input your prescriptions to be able to easily see if a plan covers them and their preferred pharmacy.

Likewise, starting in January 2025, the Medicare Prescription Payment Plan will take effect. The Medicare Prescription Payment Plan is a new payment option in the Inflation Reduction Act, also known as the prescription drug law, that works with the current drug coverage to help manage beneficiary’s out-of-pocket costs for drugs covered by their plan by spreading them across the calendar year (January–December), participation is voluntary.

How does the Medicare Prescription Payment Plan help my patient?

• For a certain set of people, it will help to manage their out-of-pocket covered drug costs. This plan is not right for everyone and does not save money for patients, but helps spread out existing costs.
• Costs are spread out across the calendar year (January – December) through monthly payments through a health plan versus in a lump sum at the pharmacy counter.

How does the Medicare Prescription Payment Plan work?

• There’s no cost to participate in the Medicare Prescription Payment Plan.
• If this payment option is selected, each month the plan premium will continue to be paid, if they have one. A bill will be received from the health or drug plan to pay, instead of paying the pharmacy
• If a person with Medicare determines this program is right for them, please have them contact their plan.

We encourage you to visit:

https://www.medicare.gov/prescription-payment-plan
https://www.medicare.gov/drug-coverage-part-d.