At the 2025 Copay, Reimbursement, and Access Congress, Carl Schmid provides a policy update on copay accumulators, maximizers. and alternative funding programs.
Speaking to the NAIC Prescription Drug Working Group, Carl Schmid described how insurers, PBMs, and 3rd party vendors harm patients by not counting manufacturer copay assistance toward out-of-pocket costs as required under the ACA; which states have banned copay accumulators; and efforts to enforce the Court ruling that requires all copay assistance be counted for patients.
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.