Cost-sharing

FDA Approves Twice-Yearly HIV Prevention Drug

Jun 18, 2025

Today marks a monumental advance in HIV prevention. Congratulations to the many researchers who spent nineteen years to get to today’s approval, backed up by the long-term investment needed to get the drug to market. Long-acting PrEP is now not only effective for up to six months but also improves adherence and will reduce HIV infections—if people are aware of it and payers, including private insurers, cover it without cost-sharing as a preventive service.

Statement on upcoming Supreme Court oral arguments on preventive services coverage requirement case

Apr 16, 2025

We urge the Court to uphold the preventive services requirement, as supported by the Trump administration. President Trump and Secretary of Health and Human Services Robert Kennedy Jr. are prioritizing prevention as a key component of making our country healthier. Preventing chronic infectious diseases such as HIV and hepatitis through testing and PrEP covered by private insurance is critically vital, especially now that the federal government is seeking to reduce spending. Without the coverage requirement, people at risk of HIV and hepatitis will likely forgo accessing the services or depend more on government programs for their testing and PrEP. However, we are not adequately addressing the needs of the uninsured today, and, given current budget constraints, which are bound to get worse, we will certainly not be able to afford the necessary preventive services for the insured without the coverage requirement. If we are to prevent infectious disease and other health conditions, the Court has no choice but to uphold access to these necessary preventive services.

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.”

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