Carl Schmid, executive director of a group called HIV+Hepatitis Policy Institute, said he believes the insurance company is violating health discrimination laws and federal regulations that say placing the majority of drugs for a medical condition on a high-cost tier is “presumptively discriminatory”.
“Due to the importance of preventing HIV and the superiority of long-acting PrEP compared to daily oral PrEP, the USPSTF acted in record speed,” Carl Schmid said. “Now we urge insurers to ensure its coverage and offer it without cost-sharing. We are hearing many complaints by people who are still being charged cost-sharing for oral PrEP and its associated services. People seeking PrEP are facing too many barriers to access and we need state and federal regulators to take the necessary steps to correct these problems.”
In a statement issued in response to the new draft recommendations, Carl Schmid, executive director of the HIV+HEP Policy Institute, noted that the Institute was pleased that the USPSTF updated its recommendations and also included long-acting cabotegravir at their request. However, Schmid also alluded to the recent news of possible violations by Blue Cross Blue Shield of North Carolina related to placement of HIV drugs in higher priced formulary tiers — a potential added barrier to getting PrEP into the hands of as many people as possible.
The HIV+Hep Policy Institute welcomes the formulary oversight and agrees that generic tiering is a “problem”
and that “plans repeatedly put generics on higher tiers,” executive director Carl Schmid told the Pink Sheet. However, he also pointed out the group is disappointed that the CMS benefit/payment parameters proposed
rule continues to allow plans to use copay accumulator programs, despite repeated efforts by the institute and
other patient groups to persuade the agency to prohibit them. Copay accumulators prevent manufacturer
assistance from being counted toward patient cost sharing requirements.
“We are hearing many complaints by people who are still being charged cost-sharing for oral PrEP and its associated services,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, in a statement. “People seeking PrEP are facing too many barriers to access and we need state and federal regulators to take the necessary steps to correct these problems.”