Consumer representatives Carl Schmid, Amy Killelea, and Deborah Steinberg presented data on prior authorization and prescription drugs to the NAIC Prescripion Drug (B) Working Group, including showing that 31 percent of first fills of brand name Rx’s were rejected due to utilization management in exchange plans.
Carl Schmid discussed with the Hepatitis B Foundation the financial challenges people living with hepatitis B face in the U.S., including high medication costs, insurance barriers, and the ongoing struggle to access affordable, life-saving treatment.
NAIC consumer representative Carl Schmid spoke at the Rx Working Group to describe how insurers continue to place HIV drugs on high-cost tiers and are not covering required treatment and PrEP drugs, and how regulators must protect patients by fully reviewing plan drug coverage and tier placement, responding to patient complaints, and ensuring $0 patient costs for preventive services.
At the 2025 Copay, Reimbursement, and Access Congress, Carl Schmid provides a policy update on copay accumulators, maximizers. and alternative funding programs.
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.”