Victory for patients reiterated–Court makes it clear: Rule requiring copay assistance to count now in effect
“We thank the Court for siding, yet again, with patients who struggle to afford their prescription drugs and rely on copay assistance,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, one of the plaintiffs in the lawsuit. “The Court has clarified what we have been asserting: the rule that states copay assistance must count is in effect. Now, that clear rule must be followed by insurers.”
Biden administration takes on insurer abuses in prescription drug coverage
“While we are pleased that CMS is taking steps to clamp down on insurers who are abusing the system by covering drugs without including them as part of essential health benefits, we are disappointed they are not directing payers to immediately count copay assistance, at a minimum, for brand name drugs without a generic alternative,” commented Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “While we understand that the case was recently decided, it will be important that CMS issue guidance that directs payers to comply now with the Court’s decision and ensure enforcement.”
From the office of Massachusetts Senate President Karen E. Spilka: Senate passes bill expanding access to HIV prevention drug
“For the first time since PrEP became available eleven years ago, over a third of the people CDC believes could benefit from being on PrEP are being prescribed it. However, there are stark and widening racial, ethnic, and gender disparities in PrEP use in Massachusetts and nationwide,” said Kevin Herwig, Health Policy Manager at HIV+Hepatitis Policy Institute. “Allowing pharmacists to prescribe PrEP, as well as to link people with PrEP clinical services and HIV testing, will help remove barriers to getting HIV preventive medication for people and communities who have not yet been able to benefit from the promise of PrEP. We thank the Senate, Senate President Spilka, Senator Cyr, and others for supporting this important legislation.”
Court strikes down HHS rule that allowed insurers to not count copay assistance
In a major victory for patients who depend on prescription drugs, Judge John D. Bates of the U.S. District Court for the District of Columbia struck down a Trump administration federal rule that allowed health insurers to not count drug manufacturer copay assistance towards a beneficiary’s out-of-pocket costs. The case was brought against the U.S. Department of Health and Human Services by the HIV+Hepatitis Policy Institute, Diabetes Leadership Council, Diabetes Patient Advocacy Coalition, and three patients who depend on copay assistance and whose insurers implemented “copay accumulator” policies.