HIV+Hep in the News

Regulators urged to be more active in preventing health insurance discrimination

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.

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Drug cost-sharing limits could be strengthened in self-insured, large group plans in upcoming rule

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.

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Admin silent on co-pay accumulators in final exchange reg, advocates eye legal options

Meanwhile, advocates have pressured state insurance commissioners to make sure insurers follow the law, and the HIV + Hepatitis C Institute is “currently exploring future legal options for patients who are currently victims of these cruel copay accumulator policies,” the group said in response to the final 2025 exchange rule out Tuesday (April 2). Patient advocates did get a partial win on another prescription drug measure included in the final exchange rule. They had cheered the administration’s proposal in the draft rule to codify its existing policy that bars individual and small group insurers from claiming certain drugs are not an essential health benefit and need not adhere to the Affordable Care Act’s cost-sharing limits, but also urged the administration to extend the policy to self-insured and group plans.

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CMS codifies EHB drug standards but punts on large group, self-insured plans; requires patient reps on P&T panels

The HIV+ Hepatitis Institute previously cheered on CMS’ proposal to block insurers from claiming certain drugs are not an essential health benefit and do not need to adhere to Affordable Care Act cost-sharing limits — but the advocacy group urged the administration to extend the proposal to all plans, not just those sold in the individual and small group markets.

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HIV, hep C funding largely maintained in Biden budget proposal

“It’s disappointing we’re facing flat funding when we have these programs, strategies and desires to end HIV, but we’re not going to do it,” Carl Schmid, gay man who is the executive director of the HIV + Hepatitis Policy Institute in Washington, D.C., told the Bay Area Reporter. “The president has proposed more money than the Congress has been allocating, but now even the president isn’t proposing the money that we need.”

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