Drug Pricing

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Prescription drug formularies, consumer protections, and state enforcement: Focus on HIV treatment & prevention

Prescription drug formularies, consumer protections, and state enforcement: Focus on HIV treatment & prevention

Mar 23, 2026

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.

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Policy updates on accumulators, maximizers, AFPs, and beyond

Nov 18, 2024

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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Patient Community Perspective

Patient Community Perspective

Feb 9, 2022

Details the harmful impacts copay accumulators have on drug adherence and patients costs, federal and state actions taken to date to ensure copay assistance counts, and advocacy opportunities at the federal and state levels patient groups can engage in relative to copay accumulators.

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ACA Appropriations Biden administration CDC Congress Copay accumulators Copay assistance Cost-sharing Drug Pricing healthcare Hepatitis Hepatitis B Hepatitis C HIV HIV Prevention Insurers Medicaid NAIC PBMs PrEP Prescription Drugs Private Insurance Ryan White Program state Testing transparency Treatment Trump administration

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