HIV+Hep in the News

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Blue Cross Blue Shield NC is discriminating against people with HIV, advocates claim

by | Dec 20, 2022

The state’s largest health insurance provider is discriminating against people with HIV by forcing them to pay more for their drugs, two advocacy groups claim in a complaint filed with the federal department of health and the North Carolina Insurance Department. Blue Cross Blue Shield of North Carolina placed nearly all standard HIV medications in drug tiers with the highest out-of-pocket costs in its 2022 and 2023 formularies, the groups say. HIV medications on lower tiers either can’t be used on their own or are no longer recommended, according to an analysis from the HIV+Hepatitis Policy Institute and North Carolina AIDS Action Network.

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USPSTF may recommend injectable PrEP, requiring ACA coverage

by | Dec 15, 2022

“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.”

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US Preventive Services Task Force issues revised draft HIV prevention recommendations

by | Dec 14, 2022

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.

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Generic tiering requirement, enhanced oversight on chronic meds proposed for marketplace plans

by | Dec 14, 2022

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.

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