HIV+Hep in the News

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Communities should lead fight against HIV/AIDS

by | Nov 21, 2023

Awareness of PrEP needs to be revitalized in minority communities, along with improving access to health care. To this end, federal and state governments must fund programs that can enable local organizations to ramp up their efforts and amplify their impact. Brian Ragas, director of Black health at the San Francisco AIDS Foundation, pointed to racism and stigma as two major barriers. Carl Schmid, executive director of the Washington, D.C.-based HIV + Hepatitis Policy Institute, concurred, and also noted that protecting federal funding for community health centers is critical. House Republicans want to decimate such federal spending, though there is a slight reprieve now as Congress has passed another continuing resolution to keep the government funded.

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Health insurers and PBMs should brace for a copay programs shift

by | Nov 20, 2023

Drugmakers’ victory in HIV and Hepatitis Policy Institute v. HHS will change how insurers and pharmacy benefit managers interact with patient copay assistance programs, as well as affect the many companies that contract with insurers to provide health coverage for their employees. The US District Court for the District of Columbia’s Sept. 29 ruling struck down the federal government’s rule that expanded use of copay accumulator programs, which insurers wielded to counteract drugmaker copay assistance programs.

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Houston, we have a problem—with discriminating against HIV+ people

by | Nov 14, 2023

“We have seen a long-standing practice of some insurers that continue to discriminate against people with HIV in the way they design their benefits. We also continue to hear of people who are using PrEP to prevent HIV being illegally charged by their insurers for this zero cost-sharing preventive service,” Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, said in a statement. “Without strict oversight and enforcement by federal and state regulators, insurers will continue to try to get away with as much as they can. That needs to stop.”

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US district court sides with patient groups on co-pay accumulators

by | Nov 9, 2023

An important legal decision produced a financial win for patients on medication affordability. On September 29, 2023, U.S. District Court Judge John D. Bates struck down a federal rule left over from the Trump Administration that previously allowed broad use of copay accumulators by insurance companies, which shifted more cost-sharing to patients. For a detailed explanation of copay accumulators, please view a previous ADAP Advocacy blog post on the subject here.

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Federal court strikes down HHS rule on copay accumulator programs

by | Nov 9, 2023

Last month, in HIV and Hepatitis Policy Institute et al v. HHS, Case No. 1:22-cv-02604-JDB (D.C. Sept. 29, 2034), the U.S. District Court for the District of Columbia struck down a Department of Health and Human Services (“HHS”) rule established under the Trump Administration that permitted (but did not require) health plans and insurers to decline to count towards a health plan participant’s annual cost-sharing obligations financial support provided by drug manufacturers to help participants pay for specific prescription drugs (e.g., discount cards, coupons, copay assistance programs). These “copay accumulator” programs are often used by insurers and pharmacy benefit managers (“PBMs”) as a way to control drug spending and prevent overutilization; however, they can operate to make participants pay more out-of-pocket for certain prescription drugs.

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