HIV+Hep in the News

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All eyes are on CMS after court reinstates copay accumulator limits

by | Oct 6, 2023

“We call on the Biden administration and states to immediately enforce this decision and not take any further steps to undermine the copay assistance that allows patients to access their essential medications,” HIV+Hepatitis Policy Institute Executive Director Carl Schmid said in a press release reacting to Bates’ ruling. With the district court’s decision, insurers will have to follow the provisions of the 2020 NBPP and use copay accumulators only for branded drugs that have a generic equivalent—if permitted by state law, the release said. (Several states have banned copay accumulators entirely for health plans they regulate, which does not include fully insured employer plans.)

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HHS ‘copay accumulator’ rule struck down: Insurers must now count copay assistance

by | Oct 5, 2023

Carl Schmid said that he hoped the Biden Administration would accept the judge’s ruling and no longer side with insurers and PBMs in the dispute. “The Biden Administration has repeatedly said that this is one of their central issues; they want to make prescription drugs cheaper for people. So, this is one way to do that,” he said. “I can’t imagine why they would appeal.” He added that employer-based plans should be aware of other attempts by PBMs and insurers to add game the system. “There are other games that the insurers are playing to take advantage of co-pay assistance,” he said. “They have to be on guard; the plans are very sneaky and they are trying to capture this copay assistance… plans have to be knowledgeable and watch out for this.”

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Houston-based health insurance agency discriminates against people with HIV, complaint alleges

by | Oct 4, 2023

A non-profit out of Washington D.C. filed a complaint against Houston-based health insurance agency Community Health Choice, claiming the organization discriminated against people with HIV. Community Health Choice is a Houston non-profit that has been providing Medicaid coverage to low-income families since its start in 1997. The complaint filed on Sept. 26 says the organization has charged large, out-of-pocket costs for drugs, placing almost all HIV medications in its most costly health insurance plan.

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Copay accumulators: Pending CMS reg may offer more clarity after judge limits scope

by | Oct 4, 2023

With the ruling, the government’s approach to copay accumulators reverts to the more limited policy. It was hailed as a major victory by the plaintiffs. “We are thrilled that the court has taken the side of patients who have been struggling to afford their prescription drugs due to the greedy actions of insurers and their PBMs,” HIV+Hepatitis Policy Institute executive director Carl Schmid said in a release. “We call on the Biden administration and states to immediately enforce this decision and not take any further steps to undermine the copay assistance that allows patients to access their essential medications.”

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Health insurers must count co-pays as patient costs, court rules

by | Oct 3, 2023

A district judge struck down a federal rule implemented under the Trump administration that allowed health insurers to ignore co-pay assistance when tabulating a patient’s out-of-pocket costs. The ruling is a win for people who need expensive prescription drugs, notably those with HIV, hepatitis, cancer, arthritis, diabetes and multiple sclerosis. It’s also a victory for the three patient advocacy groups that brought the case against the Department of Health and Human Services: the HIV+Hepatitis Policy Institute, the Diabetes Leadership Council (DLC), and the Diabetes Patient Advocacy Coalition (DPAC). Combined, the patient advocacy groups represent over 42 million people. The lawsuit also included three patients who depend on co-pay assistance and whose insurers implemented “co-pay accumulator” policies, according to the HIV+Hepatitis Policy Institute.

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