Harvard Pilgrim Health Care reversed a decision to stop covering certain HIV medications to Mainers, news of which created anxiety and confusion during the state’s open enrollment period.

The reversal, announced Monday, follows an investigation by the State Bureau of Insurance, after advocacy groups charged that proposed policy changes by the insurer, also known as Point32 Health, violated the Affordable Care Act and went against widely agreed-upon medical expertise.

The change would have applied to common HIV medications like Biktarvy, a once-daily pill. The provider will also cover all eight nationally recommended treatment regimens for HIV, the bureau said in a release Monday evening.

Bob Carey, Maine’s superintendent of insurance, applauded the reversal, but noted that it took a push by the government for the company to act.

“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 said in a written statement. “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.”

Biktarvy will be available under all plans provided via CoverME.gov, the bureau said.

The HIV + Hepatitis Policy Institute filed its initial complaint with the bureau in November, alleging that failing to cover the broadly accepted treatment regimens would discourage people with HIV from enrolling in Harvard Pilgrim’s coverage and would violate federal law.

The Affordable Care Act mandates that insurers provide “appropriate access to drugs that are included in broadly accepted treatment guidelines and that are indicative of general best practices at the time.”

The institute also noted that changes were not proposed for Harvard Pilgrim members in Massachusetts.

Carl Schmid, the institute’s executive director, said the reversal came as a surprise.

“It is amazingly good news. And it shows that the advocacy works,” he said on a Monday evening phone call. But “this is not the way that it’s supposed to work. They’re supposed to be covering the drugs in the first place.”

Schmid added that open enrollment closed last week, making the reversal essentially moot for the upcoming calendar year. But he said, assuming the laws remain unchanged, this reversal should hold up in future enrollment periods.

“They were successful in getting people not to sign up for their plan, which is unfortunate,” Schmid said. “I think a lot of people with HIV went to another plan.”

Katie Rutherford, executive director of the Frannie Peabody Center in Portland, said her agency scrambled for weeks to help clients transfer from Harvard Pilgrim to other insurers after they heard about the initial decision.

“When we saw the press release come out today from the bureau, ‘I was like, Well, the damage is done,'” she said. “Unfortunately, the timing of the reversal is such that we already had to take the steps to support people in switching carriers.”

Still, Rutherford said, the bureau’s intervention is a warning to other insurance companies who may try to skirt regulations, and she hopes similar issues that come up will be resolved more quickly following this precedent.

And while open enrollment has concluded for 2025, Rutherford noted that the change could be significant for Mainers who might become eligible for a special enrollment period later in the year. Enrollment for coverage beginning Feb. 1 is open on CoverME.gov through Jan. 15.

“Now they have options … instead of going with the one carrier who’s going to cover their meds,” Rutherford said.

The reversal also comes amid a national uproar over the ethics of health insurance companies following the killing of UnitedHealthcare’s chief executive officer earlier this month.

The reversal followed an internal review and came “in response to our members’ concerns,” a Harvard Pilgrim spokesperson said in a written statement Monday evening.

“It is important to note that existing members would have had continued coverage of Biktarvy and other HIV medications, and new members to the plan would have had coverage of equally effective medication alternatives,” the spokesperson. “Nevertheless, we made the decision to continue coverage for both existing and new members according to formulary guidelines.”

Rutherford, who was among the signatories of the institute’s November complaint, said she was first alerted to the change by a client who was informed of the news via a letter from Harvard Pilgrim. Had that person not spoken out, she said, the advocacy groups could have lost valuable time formulating their challenge.

“One of the toughest things when it comes to HIV is stigma,” Rutherford said. “It can be especially tough for a lot of folks to raise their voices when things like this happen.”

Regardless of Harvard Pilgrim’s intention, choosing to exclude HIV treatments is “not a good look” for the company, said Heather Sharkey, assistant clinical professor at the University of New England and a board-certified doctor of family medicine.

Sharkey said patients tend to remember when insurance companies treat them poorly, especially when selecting new plans.

She called choosing to exclude HIV treatments “unconscionable,” as the disease is a public health issue. She said she was glad to see the company reverse course, but noted that selecting the best insurance plan can often be tricky since there are so many variables to consider.

“It’s difficult to be a patient in the health care system in the United States,” Sharkey said. “You can do your homework, you can try to be educated, but the rules seem to change without advanced notice.”

This story has been updated to show that enrollment for part of 2025 remains open through mid-January.