HIV+Hep in the News

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Medicare now fully covers all forms of PrEP—including injectables

by | Nov 7, 2024

As for the roughly 45,000 people who currently get their PrEP through Medicare, to maintain access to care, they will need to contact their pharmacy to make sure the pharmacy can bill for Part B drugs. That’s according to HIV services coverage expert Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. Schmid says that certain large pharmacy chains like CVS and Walgreens are already in that network. If the pharmacy can’t bill for Part B drugs, Schmid recommends that people talk to their health care provider about finding a pharmacy that can. And he says that if an Advantage plan refuses to fully cover PrEP and its related services despite the government ruling, one should call the plan to tell them of the ruling—or contact Medicare directly at 1-800-MEDICARE or submit a complaint online.

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Trump wins presidency

by | Nov 6, 2024

Ending HIV and hepatitis cannot happen without a comprehensive healthcare system that includes robust private insurance, Medicaid and Medicare programs, upholding non-discrimination protections, and combating stigma and disparities. Healthcare access and affordability, particularly for prescription drugs, are critically important. We will continue to fight to ensure all payers provide the drugs people need at a price they can afford. Of immediate concern for the new administration will be ensuring that copay assistance patients receive to afford their drugs will count towards their out-of-pocket cost obligations. We look forward to working with President-elect Trump on ensuring that the Ending the HIV Epidemic initiative is fully funded and expanded in order to fulfill the goal of ending HIV in the United States. In recent years, House Republicans have proposed to eliminate funding for the program.

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HIV advocates disagree over CMS decision to nix prior auth for PrEP

by | Oct 30, 2024

“With low uptake of PrEP among the communities most impacted by HIV, this insurance coverage requirement with zero cost-sharing will help jumpstart the use of more effective forms of PrEP and lead to fewer HIV transmissions,” Carl Schmid, executive director of the HIV+ Hepatitis Policy Institute said in a statement last Monday (Oct. 21). “The updated USPSTF recommendation is not drug-specific, but rather for PrEP in general to prevent HIV, which includes ‘effective antiretroviral therapy.’ This will be important as new, longer-acting PrEP drugs become available.”

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Biden administration adds injectable PrEP requirement for insurance providers

by | Oct 23, 2024

HIV+ Hepatitis Policy Institute’s Schmid said the Biden administration was receptive to the group’s lobbying for the elimination of cost-sharing for the drug. “Without it, we feel some insurers would continue to only cover daily oral PrEP and not provide PrEP users with the choice they need,” he said. “With up to a third of privately insured PrEP users still being charged cost-sharing, we must ensure that both federal and state regulators vigorously enforce PrEP coverage requirements.”

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