“Secretary Becerra is clueless about copay accumulators, our lawsuit (against his own department), and their impact on patients,” said Carl Schmid, executive director at HIV+Hepatitis Policy Institute, in a LinkedIn post. “He actually thinks this is a Medicare issue and has no negative impact on patients getting their drugs.”
The HIV+Hepatitis Policy Institute has spotlighted the risk posed by the federal government’s refusal to enforce the court’s ruling against co-pay accumulators, shifting focus instead to addressing insurers’ classification of certain drugs as “non-essential health benefits.” While the final 2025 Notice of Benefits and Payment Parameters rule curbs the classification of covered drugs beyond state benchmarks as non-essential, the government’s inaction on co-pay accumulators marks a troubling disconnect between legal victories and their practical implementation.
Patients and advocacy groups for years have filed official comments on the annual Notice of Benefit and Payment Parameters (NBPP), urging federal officials to curtail the use of copay accumulator programs, according to Carl
Schmid, executive director of the HIV+Hepatitis Policy Institute. “And every year, they’ve completely ignored those comments,” he tells AIS Health, a division of MMIT. “This year, it was not just public comments, it was a court case that they ignored — and that they lost. It’s just remarkable, the arrogance…It just shows why patients have to speak up and ask for their rights, because the government is not always looking out for us,” Schmid says.
A group of non-profit consumer organizations is urging state regulators to perform more due diligence in guarding against health insurance discrimination in their respective states. Representatives from the National Health Law Program, the National Women’s Law Center, the HIV+Hepatitis Policy Institute and the Whitman-Walker Institute delivered a collective presentation on health insurance discrimination to the National Association of Insurance Commissioners at its recent Spring 2024 Meeting.
In a statement, HIV+Hepatitis Institute executive director Carl Schmid applauded the rule’s clarification on “non-EHB” drugs but expressed disappointment that it did not go further. “This is nonsense: everyone agrees that patients are having trouble affording their prescription drugs, that copay assistance is helping them, and that the plans are pocketing copay assistance without crediting patients, and even though the rule that allowed insurers not to count that assistance has been struck down, our federal government openly refuses to enforce the court
ruling,” he said.