Cost-sharing

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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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Congressional bills introduced to expand access to PrEP

Jun 30, 2023

“We thank the leadership of Sen. Smith, Rep. Schiff, and their 53 colleagues in re-introducing the PrEP Access and Coverage Act,” commented Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “Passage of these bills will greatly expand access to PrEP for people who have health coverage across all payers and create a national PrEP program that includes community and provider outreach as well as PrEP drugs and associated services for the uninsured. We must address head on the wide disparities in PrEP use and these bills do that.”

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