The HIV+Hepatitis Policy Institute lamented that while rates of new cases are dropping, they still remain high. The organization noted this current pace keeps the U.S. from reaching its goal of ending the HIV epidemic by 2030 and called for increased investment into this endeavor.
Since Medicaid is already required to cover these drugs, Carl Schmid said “he worried that the White House proposal was overly focused on drug prices. “The real problem is you have to get money for the outreach, the testing and the providers.”
Carl Schmid, executive director of the HIV + Hepatitis Policy Institute, particularly celebrated the rule’s application to pharmacy benefit managers (PBMs) and to health plan benefit design. “We applaud the Biden’s administration’s strengthening of the nondiscrimination regulation in order to ensure that patients, particularly those who rely on prescription drugs, are better protected against the discriminatory practices of some insurers and PBM’s,” he said. “Patients are being faced with high cost-sharing, excessive utilization management techniques, such as prior authorization, drug exclusions, and now even AI tools that decide what drugs they can receive. We can now be assured that, thanks to the ACA, they must be implemented in a nondiscriminatory manner.”
“Secretary Becerra is clueless about copay accumulators, our lawsuit (against his own department), and their impact on patients,” said Carl Schmid, executive director at HIV+Hepatitis Policy Institute, in a LinkedIn post. “He actually thinks this is a Medicare issue and has no negative impact on patients getting their drugs.”
The HIV+Hepatitis Policy Institute has spotlighted the risk posed by the federal government’s refusal to enforce the court’s ruling against co-pay accumulators, shifting focus instead to addressing insurers’ classification of certain drugs as “non-essential health benefits.” While the final 2025 Notice of Benefits and Payment Parameters rule curbs the classification of covered drugs beyond state benchmarks as non-essential, the government’s inaction on co-pay accumulators marks a troubling disconnect between legal victories and their practical implementation.