Three patient advocacy groups are suing the Biden administration over a Trump-era rule that they argue has allowed insurers and pharmacy benefit managers to increase out-of-pocket prescription drug costs for consumers. The complaint, obtained by Bloomberg Law, alleges the rule conflicts with the definition of “cost-sharing” in the Affordable Care Act and federal regulations. The rule (RIN: 0938-AT98) was issued in 2020 by the Centers for Medicare & Medicaid Services and says health insurers don’t have to count copay assistance from drugmakers toward a patient’s annual limitation on out-of-pocket costs. The HIV+Hepatitis Policy Institute, the Diabetes Leadership Council, and the Diabetes Patient Advocacy Coalition allege the policy has allowed insurance companies and pharmacy benefit managers—the entities that manage prescription drug benefits on behalf of insurers—to collect funds from both patients and drugmakers while not using any of that money to alleviate the financial burden on patients.
CMS ‘safe harbor’ for use of copay accumulators in private insurance challenged In court
Patient groups ‘left with no choice’ but to challenge federal regulation allowing commercial payers to bar manufacturer assistance with drug costs from being counted toward deductibles and out-of-pocket spending caps.
Black and Latino Americans make up most new HIV cases but only a small portion of PrEP users
Black Americans and Latinos only made up 14 percent and 17 percent of PrEP users. Meanwhile, white Americans, who represented 26 percent of new HIV diagnoses in 2021, accounted for 65 percent of PrEP users, data show.
There are multiple reasons behind the disparity in PrEP use, according to Carl Schmid, the executive director of the HIV + Hepatitis Policy Institute, but lack of community outreach and issues with having the drugs fully covered by all insurances are part of the problem.
Hepatitis C treatment restrictions in spotlight after HHS report
Study finds one-third of insured adults have access to hepatitis C treatment within 360 days of the first positive test. CDC suggests treating all eligible patients without restrictions and eliminating preauthorization requirements. For state Medicaid programs, 38 states require prior authorization and 12 states have substance use restrictions.
Less than a third of people with hepatitis C receive timely treatment
Hepatitis C can easily be cured with direct-acting antiviral therapy, but less than a third of people living with the virus are getting the treatment they need, according to the latest Centers for Disease Control and Prevention (CDC) Vital Signs report. What’s more, people who have health care coverage through Medicaid or Medicare are even less likely to receive timely treatment.