Cost-sharing

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HIV+Hep alleges Texas health plan providing substandard & discriminatory HIV drug coverage

Sep 26, 2023

Today, the HIV+Hepatitis Policy Institute filed another complaint against an insurer for violating the patient protections included in the Affordable Care Act. This time, the group alleges that Community Health Choice Texas, based in Houston, offers substandard HIV drug coverage by not covering recommended drugs for HIV treatment, including single tablet regimens, and is discriminating against people with HIV by placing most of the drugs that it does cover on the highest and most costly tier.

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Insurer responds to HIV discrimination complaint by lowering patient costs for drugs

Aug 30, 2023

Months after the HIV+Hepatitis Policy Institute and the North Carolina AIDS Action Network filed discrimination complaints against Blue Cross and Blue Shield of North Carolina for placing almost all HIV drugs on the highest drug tiers, the insurer has released a new mid-year drug formulary that leaves not a single HIV drug on the highest and most costly drug tiers. Instead of 48 HIV drugs, including many generics, on Tiers 5 and 6, there are now none.  As a result, depending on the plan, patients will be paying more reasonable and affordable costs.

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USPSTF updates PrEP recommendation to include long-acting PrEP to prevent HIV

Aug 22, 2023

“The ACA recognized the value of preventive services to individual health, public health, and reducing healthcare costs. They also help identify conditions early on when more can be done to treat them or prevent disease acquisition altogether. Insurers are simply not doing a good job of making it easy for consumers to utilize them and regulators must take action to ensure access to these mandated life-saving services,” said Carl Schmid, Executive Director of the HIV+Hepatitis Policy Institute and a Consumer Representative to the NAIC.

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Consumer Representatives to the NAIC call for regulators to shore up ACA preventive services protections

Aug 9, 2023

“The ACA recognized the value of preventive services to individual health, public health, and reducing healthcare costs. They also help identify conditions early on when more can be done to treat them or prevent disease acquisition altogether. Insurers are simply not doing a good job of making it easy for consumers to utilize them and regulators must take action to ensure access to these mandated life-saving services,” said Carl Schmid, Executive Director of the HIV+Hepatitis Policy Institute and a Consumer Representative to the NAIC.

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Medicare proposes coverage of all forms of PrEP

Jul 12, 2023

In response to CMS’ draft National Coverage Determination
(NCD) issued today that would require all Medicare plans to cover, without beneficiary cost-sharing, all forms of PrEP to prevent HIV, including long-acting PrEP, Carl Schmid, executive director of the HIV+Hepatitis Policy Institute issued the following statement: “Today’s announcement marks a huge step in ensuring Medicare beneficiaries who want to protect themselves against HIV by using either daily oral or long-acting PrEP can do so without cost-sharing. As people are living longer and remain sexually active, it is important that anyone who has a reason to be on PrEP can access it.”

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