Amid pressure from advocacy groups, Blue Cross and Blue Shield of North Carolina has removed nearly 50 HIV drugs from its most-costly drug categories. The move follows the HIV+Hepatitis Policy Institute and North Carolina AIDS Action Network filing discrimination complaints against the state’s largest health insurer for placing 48 HIV drugs at these highest tiers.
Carl Schmid, a gay man who is the executive director of the HIV+Hepatitis Policy Institute, stated, “insurers seem to try to get away with as much as they can until they are caught. While pleased to see this dramatic turnaround by the insurer, blatant discriminatory plan design and violation of the ACA’s patient protections should not happen in the first place,” Schmid stated. “For insurance to work for patients, we need better federal and state regulation, oversight, and enforcement. A drug formulary with adverse tiering should never be approved. As insurers across the country are now submitting their plans for 2024, consumers must be assured that drug formularies are being carefully reviewed to protect all beneficiaries, not just those living with HIV.”
In praising the USPSTF’s recommendations on long-acting, injectable PrEP, Schmid had called on CMS to quickly issue instructions asking insurers to cover the drug. “People seeking PrEP must not face any additional barriers as they seek to access the form of PrEP that best meets their individual needs,” the HIV+Hepatitis Policy Institute’s Carl Schmid said.
NC Blue Cross Blue Shield made widely prescribed HIV drugs unaffordable by placing them on higher-priced drug tiers. HIV+Hepatitis Policy Institute’s Carl Schmid: “That’s exactly the opposite of what we want. We want people with HIV to get the drugs they need to become virally suppressed and healthy. When they don’t get the drugs they need, they become sick and can pass on the virus to other people as well. This is a wakeup call not just for HIV drugs but for other drugs as well that other people rely on. Insurers just can’t do this.”
“While pleased to see this dramatic turnaround by the insurer, blatant discriminatory plan design and violation of the ACA’s patient protections should not happen in the first place,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “Insurers seem to try to get away with as much as they can until they are caught. For insurance to work for patients, we need better federal and state regulation, oversight, and enforcement. A drug formulary with adverse tiering should never be approved.”