One part of the HELP Copays Act would close the “essential health benefits loophole.” Carl Schmid said insurers take drugs associated with copay assistance off essential health benefits so there are no copay limits. The bill mandates that any drug that is offered on a plan has to be on essential health benefits. “The PBMs and insurers are very conniving,” Schmid alleges. But Schmid said the bill will be hard to pass because the issue isn’t well known.
New copay ruling could impact millions of prescription drug users. What to know
In 2022, copay cards covered $19 billion worth of out-of-pocket costs for patients, according to Carl Schmid, executive director at the HIV + Hepatitis Policy Institute. “Imagine if we didn’t have that? The American people would have to come up with 19 more billion dollars,” Schmid told McClatchy News.
A federal court just struck down copay accumulators
“This ruling is a big win for people living with HIV and [people taking] other prescription drugs who have a hard enough time already affording their meds,” TheBody was told on a call by Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. He also said in a press release: “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 pharmacy benefits managers. 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.”
PrEP coverage is improving, but remains uneven across demographics
“The low usage of PrEP among the communities most impacted by HIV points to the need for increased and targeted federal resources,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute.
PrEP prescriptions on the rise
“While the data demonstrate progress in PrEP usage, which will translate into fewer new HIV transmissions, the low usage of PrEP among the communities most impacted by HIV points to the need for increased and targeted federal resources,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute.