HIV+Hep in the News

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Biden’s CMS added brand PrEP to exchange RA to spur coverage, advocates mixed

by | Jan 24, 2025

Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, told Inside Health Policy excluding generics from the risk adjustment is fair because they are not a large cost to an insurance company in comparison to the branded drug. If generics were included, an insurer would receive credit for spending less money than another insurer providing a higher cost brand name long-acting drug. Schmid also noted that CMS is anticipating more people will be using branded PrEP than the less expensive generic alternatives, though new forms will be coming out and all insurers must cover the treatment at zero cost sharing.

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Patients left to cost-sharing for therapies without federal government intervention

by | Jan 23, 2025

The insurance companies fought us in court. We won, and they said we’re going to issue a new rule. Well, that was over a year ago. We thought it would be included, as well as define what cost sharing is and if copay assistance must count in terms of cost sharing. They could go the other way too and say that copay assistance can’t count. So they punted. They just said in the proposed rule that we’re going to issue a further rule regarding our case and the definition of cost sharing regarding patient manufacturer assistance to patients. We’re asking them to comply with the court order, and said that the 2020 rule is now in effect—that cost sharing must count for brand name drugs, except if there’s a generic alternative.

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Harvard Pilgrim Health Care offered discriminatory plans to people living with HIV

by | Jan 22, 2025

According to Carl Schmid, Executive Director of the HIV+Hepatitis Policy Institute, more vigorous enforcement would be a solution to discriminatory plan design. For example, in Texas, the Affordable Care Act guidelines are not enforced by the state insurance regulator but are enforced by the federal government. Moreover, the federal government constructs templates delineating ACA appropriate coverage guidelines for insurance plans to follow. Schmid explains that the templates in use are outdated, thus not reflecting current best practices. Hence, the federal government is not effectively engaging in enforcement.

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Advocates concerned over RFK Jr.’s prior comments on HIV, urge senators to inquire if he still supports past statements

by | Jan 22, 2025

In letters to the Senate health and Finance committees, HIV+Hepatitis Policy Institute Executive Director Carl Schmid urges lawmakers to ensure the next HHS secretary will lead with science and continue President Donald Trump’s 2019 program to end the HIV epidemic. Schmid explained in his letters to the committees that Trump pledged in his 2019 State of the Union speech to “eliminate the HIV epidemic in the United States within ten years” and then announced the Ending the HIV Epidemic (EHE) program that boosts HIV testing, treatment and prevention programs. Schmid noted the initiative was continued by former President Joe Biden and the program’s jurisdictions have seen a 21% decrease in new infections between 2019 and 2023. The country saw a 6% decrease.
“It is essential that the next HHS Secretary continues the President’s Ending the HIV Epidemic initiative; commits to supporting research, science, and best practices; and confronts the stigma and discrimination often associated with HIV to finally end HIV,” the letter says.

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Biden admin fails to address copay accumulators as term ends

by | Jan 17, 2025

Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, told Inside Health Policy the new administration does not need to issue new guidance to enforce the court decision. “Follow the court decision,” Schmid said. “Tell states that they have to comply and tell insurers that they have to comply.” A federal judge affirmed in January 2024 that a provision in the 2020 exchange rule barring insurers from using copay accumulators for certain branded drugs is still in effect, since the 2021 NBPP that let insurers use the mechanism was vacated in a September ruling. HHS initially appealed the ruling, but weeks later the Department of Justice dropped the suit.

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