A key patient advocate sees the final 2023 exchange rule as a mixed bag for reducing drug prices. Carl Schmid, executive director at the HIV+Hepatitis Policy Institute, touts the requirement that insurers offer standardized health plan options alongside any non-standardized Qualified Health Plans (QHPs) as a positive step for patients that rely on prescription drugs. However, Schmid is upset that the administration continues to avoid requiring insurers to count copay assistance toward out-of-pocket costs.
HIV PrEP is supposed to be covered, but often isn’t
Medications that prevent HIV — along with the necessary doctor’s visits and lab tests — are supposed to be fully covered by most insurance plans under the Affordable Care Act. Patients and advocacy groups tell Axios they’re often not. Why it matters: Studies show HIV pre-exposure prophylaxis, often called PrEP, is more than 90% effective in preventing the transmission of HIV. But the brand-name version of the daily pill costs upward of $20,000 a year, and billing problems that shift costs to patients lead many who would benefit to opt out, advocates say.
Insurers across the U.S. are often illegally charging for PrEP
According to Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, insurers in several states aren’t covering PrEP drugs at no cost to beneficiaries. Schmid tells TheBody that he’s been getting many complaints from patients across the country about being illegally charged for PrEP—and, more commonly, for related services like labs. “I don’t want to characterize intent, but some plans are more transparent about billing than others,” he says.
Biden allocates $850M to end HIV epidemic
In his latest budget, President Joe Biden has proposed an increase of $377 million, for a total of $850 million, toward federal government efforts to end the HIV epidemic by 2030. Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, was very pleased with Biden’s efforts as he makes good on his commitment to end HIV in the U.S by calling for increased funding for HIV prevention, care, and treatment programs in jurisdictions with the highest levels of HIV.
Biden budget proposes $9.8 billion for national PrEP program
The Biden administration this week pledged to invest additional funds into an existing program to combat the nation’s HIV epidemic, aiming to eradicate the infection that causes AIDS by 2030. The president in his fiscal year 2023 budget proposal promised an increase of $377 million for the Ending the HIV Epidemic in the U.S. (EHE) initiative, an ambitious plan announced in 2019 seeking to end HIV within the next decade. The budget commits to a 75 percent reduction in HIV infection by 2025.