NAIC Consumer Reps. Carl Schmid and Deb Darcy discuss barriers consumers face in accessing healthcare through the high number of prior authorizations and the appeals and denials process, and request the NAIC develop a workstream that improves data collection, and consumer awareness of the appeals process, update model laws, and better enforcement of federal and state laws and regulations.
Tackling copay accumulator and maximizers
Carl Schmid participates in the “Prescription for Better Access” podcast with Lauren Crawford Shaver and hosts Mark Hansan and Dr. Scott Howell to examine how PBM copay accumulator and maximizer policies harm patients by not counting copay assistance toward patient out-of-pocket costs and deductibles, and what can be done to keep prescription drugs accessible and affordable.
Barriers to health care for consumers with insurance: Prior authorization
NAIC Consumer Representative Carl Schmid speaks at the 2023 NAIC Spring Meeting on a panel about how insurers create barriers to prescription drugs through onerous prior-authorization requirements.
Patients still face difficulties in accessing PrEP for free
Carl Schmid speaks with “Houston Matters” radio, along with a San Antonio, Texas PrEP client, about private insurers continuing to charge cost-sharing for PrEP and associated services and its impact on PrEP uptake.
Discrimination in prescription drug formularies
Carl Schmid discusses discrimination in prescription drug formularies, demonstrating how some PBMs and private insurers violate ACA provisions and hurt patients by placing life-saving prescription drugs on higher cost tiers.