Carl Schmid presents to NAIC Special Committee on Race & Insurance on how insurance benefit design impacts prescription drug access for racial and ethnic communities and suggestions for overcoming access barriers by reducing utilization management measures, lowering cost-sharing, offering standardized plans, and enforcing ACA non-discrimination policies.
It’s a real shame that not enough people are taking PrEP [preexposure prophylaxis] that should be. The CDC [Center for Diseases Control] indicates probably 1.2 million people are eligible to take PrEP, and only around 28% of those people eligible are currently taking it. There’s a number of reasons why. One, people don’t know about it. It’s still relatively new. In the communities that we need to reach—particularly black gay men, Latino gay men, black women—they’re not aware of it. It’s also a burden. You have to take a drug every day for a disease [when] you’re not sick. That’s changed. Some of the pills could be large, and that could be an issue. There are smaller pills right now, but you have to take the drug every day. It’s not just taking the pill. You have to be tested periodically for HIV. You have to make sure that you’re not living with HIV, and you have to go to the clinic or the doctor periodically for a certain test as well. It is a commitment, and there are a lot of hurdles. People may think that there’s a cost associated with it and too many steps and prior authorizations that people have to go through.
On World Hepatitis Day, Contagion Live community podcast featured HIV+Hep’s Carl Schmid discussing the challenges in the fight against viral hepatitis: “Every 30 seconds someone is dying of hepatitis, & the sad thing is people don’t even know about it. Like HIV, there is so much stigma. . . . It all comes down to testing. This is an infectious disease, remarkably, that can be cured. But we need more resources.”
Copay assistance provides a safety net to help patients afford and adhere to medically-necessary medications. But, the Centers for Medicare & Medicaid Services (CMS) Best Price Rule, finalized by the Trump administration in 2020, threatens patient access to these critical programs. If implemented, the final rule would allow insurers and pharmacy benefit managers (PBMs) to undermine copay assistance through copay accumulator adjustment programs that block patient assistance from counting towards a patient’s deductible and out-of-pocket cost-sharing requirements. Watch this virtual briefing to learn about the value of patient copay assistance programs and how you can get engaged to protect communities from the unintended consequences of the CMS Best Price Rule.
A discussion on Chronic Care Policy Alliance’s priorities and tips on how to reach out to elected officials.