Presentations

;
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.

read more
Diversion of patient copay assistance by insurers, PBMs & third-party vendors

Diversion of patient copay assistance by insurers, PBMs & third-party vendors

May 19, 2025

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.

read more
Consumer perspectives on insurer denials, prior authorization & appeals

Consumer perspectives on insurer denials, prior authorization & appeals

Mar 25, 2025

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.

read more

Search

Tags

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

Recent Presentations

Pin It on Pinterest