Carl Schmid presented at the NAIC Spring Meeting on patients’ growing frustration with insurers’ increasing use of prior authorization requirements. In reaction, states are taking action and passing laws requiring greater data collection and transparency and limiting the use of AI in prior authorization.
STI clinics are an important setting for the provision of HIV pre-exposure prophylaxis (PrEP) and are also one of the fastest growing categories of the 340B drug discount program. The HIV+Hepatitis Policy Institute engaged BRG to determine how STD clinics are using the 340B program to fight HIV and viral hepatitis. BRG examined STD clinic enrollment trends over time using the HRSA 340B database in order to learn what types of clinics were enrolling and how they were able to obtain their 340B designation (direct or indirect funding). BRG also examined Medicaid claims in five states and Medicare claims nationally to identify which drugs were prescribed by providers at enrolled STD clinics, comparing PrEP and HIV/viral hepatitis treatment drugs with other drugs.
Carl Schmid presented at the NAIC Spring Meeting on how PBMs impact patient drug costs and access to drugs by placing drugs on high-cost tiers and not counting copay assistance toward patient out-of-pocket costs. He reviews state and federal actions to stop these harmful practices.
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.”
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.