Cost-sharing

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From the office of Gov. Phil Murphy: Governor Murphy signs legislation bolstering health care affordability and accessibility

Jan 9, 2026

“Patients with HIV, hepatitis, and so many other health conditions rely on copay assistance to afford their drugs. Healthcare is already expensive and when insurers add additional barriers and costs, such as not counting copay assistance towards a patient’s deductible, patients’ costs significantly increase, jeopardizing medication adherence and their health,” said Carl Schmid, Executive Director, HIV+Hepatitis Policy Institute. “We applaud Governor Murphy for signing this bipartisan legislation to put an end to hidden insurer practices that drive up patient costs.”

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Patient groups file amicus brief in imported HIV drug scheme

Jan 2, 2026

“Forcing a person who has employer sponsored health insurance to sign up with an unknown third-party vendor to receive their life-saving drug supplied by a foreign country not only is illegal but jeopardizes the health and safety of patients,” commented Carl Schmid, Executive Director of the HIV+Hepatitis Policy Institute. “In an effort to evade actual coverage of specific prescription drugs that the health insurance plan states it covers, middlemen are profiting by scheming to set up so-called ‘alternative funding programs.’  While federal regulators should be shutting them down, in the meantime, the courts must step in to protect patients.”

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Insurer adds HIV treatments after discrimination complaints

Dec 2, 2025

We are pleased to see the improvements in Medica’s coverage of HIV drugs. While it took a year, with two letters and a great deal of research, we are grateful to the Iowa insurance department for working with Medica on these changes. Though we never received a formal response from the Minnesota insurance department, we assume our c omplaint played a major role in that state as well. Despite the substantial improvements in Medica’s formularies, the issuer still offers substandard coverage and remains an outlier when compared to other issuers on the Iowa and Minnesota Marketplaces, as we have detailed in follow-up letters to regulators in both states.

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CVS health refusing to cover new long-acting PrEP drug

Aug 21, 2025

CVS Health’s decision is a clear violation of the ACA’s requirement to cover USPSTF-recommended preventive services, including PrEP. The entire world is excited by this drug and its potential contribution to preventing and eventually ending HIV. However, a drug will only work if people can access it and right now CVS Health, which owns the largest pharmacy benefit manager in the country, is shamefully blocking people from taking it, unlike other payers. We urge CVS, which has been committed to ending HIV in the past, to reconsider their decision immediately. Additionally, we call on federal and state regulators to ensure that plans are in compliance with the federal government’s PrEP coverage guidance and the many state laws that require coverage of all PrEP drugs.

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Supreme Court upholds preventive services coverage requirements

Jun 27, 2025

This is a great victory for healthcare in our country and for everyone who believes in prevention, including the Trump administration. This legal attack was initiated by extreme right-wing social conservatives who sought to make sure that gay men and others could not access PrEP to prevent HIV. We are very pleased the Court upheld the coverage requirement. Now we must focus on making sure insurers comply with and regulators enforce the law, particularly with new, long-acting forms of PrEP. This victory is all the more important now that the Trump administration is seeking to defund much of CDC’s HIV and hepatitis prevention programs. While we continue to oppose those proposed funding cuts, we can rest assured that at least for people with insurance, preventive services such as PrEP, HIV and hepatitis testing will be covered at no cost.

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