ACA

PBM reform: The challenges of PrEP access

PBM reform: The challenges of PrEP access

Carl Schmid, Executive Director, HIV+Hepatitis Policy Institute, Washington, D.C., spoke about copay accumulator programs and why they must stop. He sat down with Managed Healthcare Executive afterward and explained how HIV medications are involved and why cost sharing is supposed to be free for specific forms of PrEP – but isn’t. “We’re still finding that, despite the ACA requirements that preventive drugs such as PrEP should be free, both for drugs and for the ancillary services, around one-third of all people are being charged and cost sharing and it’s a real deterrent to people,” Schmid said in an interview with Managed Healthcare Executive. “One of the problems is that the providers don’t know the billing codes, and then [insurance companies] just deny.”

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Oral comments before the Federal Trade Commission on PBM Practices

Oral comments before the Federal Trade Commission on PBM Practices

Schemes like refusing to count copay assistance toward patient out-of-pocket costs and designating some medications as “non-essential health benefits” allow PBMs and their insurance partners and others to make more money and profit at the expense of patients who are having trouble affording their drugs. We urge you the Federal Trade Commission to continue your investigation and take appropriate action to stop them.

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Policy updates on accumulators, maximizers, AFPs, and beyond

Speaking at InformaConnect’s #Copay2024, Kevin Herwig gave a policy update on developments related to copay accumulators, maximizers, and alternative funding programs and the failure of HHS to enforce the HIV+Hepatitis Policy Institute’s Court victory a year ago or fully close the loophole allowing insurers to designate prescription drugs as non-essential health benefits.

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Copay accumulator plan designs: What life sciences manufacturers need to know heading into 2024

Copay accumulator plan designs: What life sciences manufacturers need to know heading into 2024

Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, and Bill Sarraille, a partner with Sidley law, speak with Michael Harris, Mercalis’s VP of Patient Support Services Strategy, on the litigation brought by the HIV+Hepatitis Policy Institute against a federal government rule allowing insurers to not count copay assistance toward patient costs. The Court ruled in favor of patients but the government appealed and is refusing to enforce the Court’s ruling.

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