“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.
Carl Schmid, executive director of the HIV + Hepatitis Policy Institute, noted in a news release the Affordable Care Act mandates PrEP be covered without cost-sharing since it is a preventative service. “Insurers should not be given the choice to cover just daily oral PrEP, particularly given these remarkable results. 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 now must cover,” Schmid said in a statement.
Carl Schmid, executive director of the D.C.-based HIV+ Hepatitis Policy Institute, called Lenacapavir a “miracle drug” based on the latest studies, saying the optimistic findings pave the way for the potential approval of the drug by the U.S. Food and Drug Administration in 2025. “The goal now must be to ensure that people who have a reason to be on PrEP are able to access this miracle drug,” Schmid said in a Sept. 12 press release. “Thanks to the ACA [U.S. 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 in the release. “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.
The 2026 draft NBPP is “at the White House right now,” says Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. He tells AIS Health, a division of MMIT, that it has been there since July 17 and that he expects it to be released “any day now.” Presumably, it will address the definition of cost sharing and HHS’s stance on accumulators. “We’re hoping that it’s going to be in there.” He points out that it’s been almost one year since the court made its decision on the case in which his organization was a plaintiff. “Every day that they don’t issue a decision, people are being hurt.…There needs to be some outrage over this.”