ACA

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Twice a Year HIV Prevention Drug May Soon Be Available

Sep 12, 2024

The goal now must be to ensure that people who have a reason to be on PrEP are able to access this miracle drug. Thanks to the ACA, insurers must cover PrEP without cost-sharing as a preventive service.  Insurers should not be given the choice to cover just daily oral PrEP, particularly given these remarkable results . The Biden-Harris administration should immediately make that clear.  To date, they have yet to do that for the first long-acting PrEP drug that new plans now must cover.

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Biden administration strengthens patient protections in accessing prescription drugs

Apr 26, 2024

“We applaud the Biden administration’s strengthening of the nondiscrimination regulation in order to ensure that patients, particularly those who rely on prescription drugs, are better protected against the discriminatory practices of some insurers and PBMs,” commented Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “Patients are being faced with high cost-sharing, excessive utilization management techniques, such as prior authorization, drug exclusions, and now even AI tools that decide what drugs they can receive. We can now be assured that, thanks to the ACA, they must be implemented in a nondiscriminatory manner.”

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Federal Government Refuses to Enforce Copay Assistance Court Victory, But Moves to Stop Scheme of Classifying Drugs as “Non-Essential Health Benefits”

Apr 2, 2024

“This is nonsense: everyone agrees that patients are having trouble affording their prescription drugs, that copay assistance is helping them, and that the plans are pocketing copay assistance without crediting patients, and even though the rule that allowed insurers not to count that assistance has been struck down, our federal government openly refuses to enforce the court ruling,” commented Carl Schmid, executive director of the HIV+Hepatitis Policy Institute.

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Federal civil rights office gives pass to insurer for HIV discrimination

Feb 13, 2024

“While it is reassuring that OCR formally investigated our complaint, the harm to people living with HIV has been going on for years. This was blatant discriminatory plan design and the entities charged with enforcing ACA’s patient protections let Blue Cross Blue Shield North Carolina off with not even a slap on the wrist,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “This is further proof that insurers are allowed to get away with as much as they can. And even when they are caught, there is no penalty. For insurance to work for people living with HIV and all patients, we need better federal and state regulation, oversight, and enforcement.”

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With Court victories, patient groups drop appeal in copay assistance case

Feb 2, 2024

“Now that the court has struck down the rule that allowed insurers and PBMs not to count copay assistance and clarified that the previous rule—requiring copay assistance to count in most instances—is now in effect, we now must turn to enforcement to ensure patients are no longer being financially harmed by copay accumulators,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, one of the plaintiffs in the lawsuit. “We are already hearing from patients that insurers are still subjecting them to these unscrupulous and now, illegal practices, and we will ensure that any unlawful practices stop.”

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