HIV+Hepatitis Policy Institute, an advocacy group, criticized the proposed rule’s impact on patients, saying the government is still letting pharmacy benefit managers profit from copay assistance. The rule included no requirements that copay assistance be counted as part of patient cost-sharing and no provision closing an essential health benefits loophole.
“We commend the Biden-Harris administration for increasing PrEP uptake using all the tools at its disposal,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, in a press statement. “Patient cost-sharing has been a significant barrier for Medicare beneficiaries. With this new NCD [National Coverage Determination], people on Medicare can join those with private insurance who can access PrEP without cost-sharing. Now we have to make sure these policies are properly implemented and enforced.”
Every day these rules are delayed is another day that insurers and PBMs are pocketing billions of dollars meant for patients who are struggling to afford their drugs,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, in a statement. “Coming from an administration that prides itself on supporting patients and lowering their prescription drug costs, this is a huge disappointment. While they have gone on record that they will issue these rules, the clock is ticking and there isn’t much time left.”
“Patient cost-sharing has been a significant barrier for Medicare beneficiaries. With this new NCD, people on Medicare can join those with private insurance who can access PrEP without cost-sharing. Now we have to make sure these policies are properly implemented and enforced,” Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, said in a statement Tuesday.
“The goal now must be to ensure that people who have a reason to be on PrEP are able to access this miracle drug,” Carl Schmid said in a press release. “Thanks to the ACA (Affordable Care Act), insurers must cover PrEP without cost sharing as a preventive service,” he said. “Insurers should not be given the choice to cover just daily oral PrEP, particularly given these remarkable results,” Schmid said. “The Biden-Harris administration should immediately make that clear. To date, they have yet to do that for the first long-acting PrEP drug that new plans must cover,” he said.