“The goal now must be to ensure that people who have a reason to be on PrEP are able to access this miracle drug,” Carl Schmid said in a press release. “Thanks to the ACA (Affordable Care Act), insurers must cover PrEP without cost sharing as a preventive service,” he said. “Insurers should not be given the choice to cover just daily oral PrEP, particularly given these remarkable results,” Schmid said. “The Biden-Harris administration should immediately make that clear. To date, they have yet to do that for the first long-acting PrEP drug that new plans must cover,” he said.
Advocates call for CMS guidance as Gilead’s twice-yearly PrEP shows promise
Carl Schmid, executive director of the HIV + Hepatitis Policy Institute, noted in a news release the Affordable Care Act mandates PrEP be covered without cost-sharing since it is a preventative service. “Insurers should not be given the choice to cover just daily oral PrEP, particularly given these remarkable results. The Biden-Harris administration should immediately make that clear. To date, they have yet to do that for the first long-acting PrEP drug that new plans now must cover,” Schmid said in a statement.
New twice-a-year HIV prevention drug found highly effective
Carl Schmid, executive director of the D.C.-based HIV+ Hepatitis Policy Institute, called Lenacapavir a “miracle drug” based on the latest studies, saying the optimistic findings pave the way for the potential approval of the drug by the U.S. Food and Drug Administration in 2025. “The goal now must be to ensure that people who have a reason to be on PrEP are able to access this miracle drug,” Schmid said in a Sept. 12 press release. “Thanks to the ACA [U.S. Affordable Care Act], insurers must cover PrEP without cost sharing as a preventive service,” he said. “Insurers should not be given the choice to cover just daily oral PrEP, particularly given these remarkable results,” Schmid said in the release. “The Biden-Harris administration should immediately make that clear. To date, they have yet to do that for the first long-acting PrEP drug that new plans must cover,” he said.
As Biden admin winds down, will it address accumulators, maximizers as promised?
The 2026 draft NBPP is “at the White House right now,” says Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. He tells AIS Health, a division of MMIT, that it has been there since July 17 and that he expects it to be released “any day now.” Presumably, it will address the definition of cost sharing and HHS’s stance on accumulators. “We’re hoping that it’s going to be in there.” He points out that it’s been almost one year since the court made its decision on the case in which his organization was a plaintiff. “Every day that they don’t issue a decision, people are being hurt.…There needs to be some outrage over this.”
SF AIDS agency ends direct services as disparity seen in local, federal new Latino HIV diagnoses
Carl Schmid, a gay man who is executive director of the Washington, D.C.-based HIV+Hepatitis Policy Institute, told the B.A.R. in a phone interview that nationally “it’s gay men and younger people in particular” who are being affected, and that “you have to look at how funding is allocated in each jurisdiction” to see if it’s being effective. “You need to look at PrEP stats, too: that they are lower for Latinos as well,” Schmid said. “Among all Latino gay men, 46% of all new infections were ages 25-34; 19% were ages 13-24. … There’s a lot of barriers to PrEP, insurance barriers, but we really need to be focusing more outreach for our PrEP programs in the Latino community. This is, I feel, an overlooked problem.”