Cost-sharing

Insurer agrees to add HIV drugs after discrimination complaint filed

Dec 17, 2024

“While this action is certainly welcome, the fact remains that Harvard Pilgrim removed lifesaving HIV drugs from its coverage formulary, disrupted the treatment of people living with HIV, and violated the ACA’s nondiscrimination protections,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “This demonstrates the need for greater oversight of the health insurance industry and enforcement of the safeguards in place to protect patients against the abuse of insurers.”

HIV discrimination complaints filed in five states against insurers for substandard drug coverage & high cost-sharing

Nov 15, 2024

“We continue to uncover private insurers that engage in discriminatory plan design by using drug formularies that discourage enrollment of people living with HIV. Putting every HIV drug, including cheap generics, on the highest cost-sharing tier and not covering drugs necessary to treat HIV are blatant examples of discrimination,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “Without proper regulation and enforcement, some insurers will try to get away with whatever they can. We call on the state insurance regulators to act quickly on these complaints and immediately ensure these insurers come into compliance.”

Biden-Harris administration urged to comply with court decision & require insurers to count copay assistance

Nov 13, 2024

“In the closing days of this administration they must do the right and very simple thing to help patients afford their prescription drugs—tell insurers that they must comply with the Court decision,” commented Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “They have been disregarding the law for over a year, haven’t issued a promised new rule, and time is running out. They need to stop siding with the powerful insurers and their PBMs, and instead side with patients.”

Biden-Harris administration requires insurers to cover long-acting PrEP to prevent HIV

Oct 21, 2024

With low uptake of PrEP among the communities most impacted by HIV, this insurance coverage requirement with zero cost-sharing will help jumpstart the use of more effective forms of PrEP and lead to fewer HIV transmissions. We are grateful to the Biden-Harris administration for responding to our request to issue this guidance. Without it, we feel some insurers would continue to only cover daily oral PrEP, and not provide PrEP users with the choice they need. With up to a third of privately insured PrEP users still being charged cost-sharing, we must ensure that both federal and state regulators vigorously enforce PrEP coverage requirements.

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.”

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