Copay accumulators

Biden-Harris administration sides with insurers & fails to take steps to lower patient costs for prescription drugs

Oct 4, 2024

“Every day these rules are delayed is another day that insurers and PBMs are pocketing billions of dollars meant for patients who are struggling to afford their drugs,” commented Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “Coming from an administration that prides itself on supporting patients and lowering their prescription drug costs, this is a huge disappointment. While they have gone on record that they will issue these rules, the clock is ticking and there isn’t much time left.”

Senate appropriators maintain funding for domestic HIV & hepatitis programs

Aug 2, 2024

“We sincerely thank Senate Labor HHS Appropriations Subcommittee Chair Tammy Baldwin and Ranking Member Shelley Moore Capito and their colleagues for demonstrating their continued commitment to ending HIV in the United States. While working within the confines of an extremely restrictive budget, they crafted a spending bill that prioritizes the domestic response to HIV,” commented Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “However, given that the House version of the bill includes sizeable funding cuts, program eliminations and divisive policy riders, we realize passage of this spending bill is far from reality. House Republicans must come to the table and support bills, such as this one, that can pass the Congress and be signed by the President.”

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.

After court victories, HIV+Hep calls on state insurance regulators to enforce copay assistance rule

Mar 13, 2024

Unfortunately, since the court ruling nearly six months ago, we continue to hear from patients complaining that insurers are not counting the copay assistance that they receive, and are being saddled with thousands of dollars in unanticipated out-of-pocket costs for their prescription drugs. Some insurers have told their enrollees that they will not enforce the court ruling without regulator action or a court order.

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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