“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.”
Carl Schmid, executive director of the HIV+HEP Policy Institute, is hopeful that ongoing legal action the institute and two other organizations took against the government on the issue may lead to the change the group is pushing for, as he said patient advocates have seen “no action by the federal government on this issue.”
Copay coupons are currently banned by Medicare but allowed in the commercial market, including for Affordable Care Act plans. The final 2021 NBPP rule allowed enforcement of copay accumulator programs, and the agency has continued to permit the policy since then, despite long-standing objections from patient groups.
“We are extremely pleased that the USPSTF, at our request, has updated its recommendation for PrEP to prevent HIV and include newly approved long-acting drugs,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, in statement. “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. Now we urge insurers to ensure its coverage and offer it without cost-sharing.”
Two HIV/AIDS patient advocacy organizations have filed discrimination complaints against North Carolina Blue Cross Blue Shield, alleging that its drug formulary discriminates against patients with HIV because almost all drugs to treat and prevent the condition are placed on its highest cost-sharing tier. The HIV+Hepatitis Policy Institute (HPI) and the North Carolina AIDS Action Network announced Thursday (Dec. 8) that they were filing complaints with the North Carolina Department of Insurance and the Office of Civil Rights at HHS, alleging that the insurer is requiring HIV patients, or those aiming to prevent HIV infection, to pay unfairly high costs.
Two HIV advocacy groups allege Blue Cross Blue Shield of North Carolina is violating antidiscrimination requirements by pricing HIV drugs in high cost-sharing tiers. The HIV+Hepatitis Policy Institute and the North Carolina AIDS Action Network filed complaints with the HHS civil rights department and the North Carolina insurance department Dec. 8. In the complaints, the organizations claim BCBS North Carolina places most drugs for HIV treatment, including generics, in higher formulary tiers, which mean higher cost-sharing rates for patients.