A lack of funding, fears around data sequestration, and resistance to expanding sexual health measures are all reasons pointing to delays for increasing access to PrEP for uninsured and underinsured patients. While the U.S. Preventive Services Task Force (USPSTF) last month made headway for insured patients by giving it an “A” grade, questions remain about access for those without insurance.
“Unlike HIV, where you have it for the rest of your life, with hepatitis C it’s a very short time frame, just eight to 12 weeks, and you’re cured,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “So why aren’t we doing a better job?”
Thousands of North Carolina residents living with HIV in North Carolina now have lower out-of-pocket expenses after Blue Cross and Blue Shield of North Carolina changed its pricing formula for dozens of HIV treatment medications. The move came months after advocates accused the state’s largest health insurer of discriminating against these patients by placing nearly all standard HIV medications in drug tiers with the highest out-of-pocket costs.
Amid pressure from advocacy groups, Blue Cross and Blue Shield of North Carolina has removed nearly 50 HIV drugs from its most-costly drug categories. The move follows the HIV+Hepatitis Policy Institute and North Carolina AIDS Action Network filing discrimination complaints against the state’s largest health insurer for placing 48 HIV drugs at these highest tiers.
Carl Schmid, a gay man who is the executive director of the HIV+Hepatitis Policy Institute, stated, “insurers seem to try to get away with as much as they can until they are caught. While pleased to see this dramatic turnaround by the insurer, blatant discriminatory plan design and violation of the ACA’s patient protections should not happen in the first place,” Schmid stated. “For insurance to work for patients, we need better federal and state regulation, oversight, and enforcement. A drug formulary with adverse tiering should never be approved. As insurers across the country are now submitting their plans for 2024, consumers must be assured that drug formularies are being carefully reviewed to protect all beneficiaries, not just those living with HIV.”