Since Medicaid is already required to cover these drugs, Carl Schmid said “he worried that the White House proposal was overly focused on drug prices. “The real problem is you have to get money for the outreach, the testing and the providers.”
Carl Schmid, executive director of the HIV + Hepatitis Policy Institute, particularly celebrated the rule’s application to pharmacy benefit managers (PBMs) and to health plan benefit design. “We applaud the Biden’s administration’s strengthening of the nondiscrimination regulation in order to ensure that patients, particularly those who rely on prescription drugs, are better protected against the discriminatory practices of some insurers and PBM’s,” he said. “Patients are being faced with high cost-sharing, excessive utilization management techniques, such as prior authorization, drug exclusions, and now even AI tools that decide what drugs they can receive. We can now be assured that, thanks to the ACA, they must be implemented in a nondiscriminatory manner.”
“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.