Drug Pricing

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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.”

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Federal civil rights office gives pass to insurer for HIV discrimination

Feb 13, 2024

“While it is reassuring that OCR formally investigated our complaint, the harm to people living with HIV has been going on for years. This was blatant discriminatory plan design and the entities charged with enforcing ACA’s patient protections let Blue Cross Blue Shield North Carolina off with not even a slap on the wrist,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “This is further proof that insurers are allowed to get away with as much as they can. And even when they are caught, there is no penalty. For insurance to work for people living with HIV and all patients, we need better federal and state regulation, oversight, and enforcement.”

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Biden administration takes on insurer abuses in prescription drug coverage

Nov 16, 2023

“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.”

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Biden administration begins to address patient affordability of medications: but fails to ensure copay assistance counts as patient cost-sharing

Dec 28, 2021

The Biden administration released a proposed rule that will govern how private health plans must operate in 2023 and in doing so, took some steps to limit patient cost-sharing for prescription drugs. However, despite the urging from patient groups, they are not requiring insurers and pharmacy benefit managers (PBMs) to count copay assistance towards patient out-of-pocket cost-sharing and deductibles.

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Biden administration passes on protecting patient affordability of medications

Apr 30, 2021

“We are deeply disappointed that CMS passed on addressing the issue of copay assistance for prescription drugs and requiring insurers and pharmacy benefit managers (PBMs) to count assistance towards patient out-of-pocket cost-sharing and deductibles,” commented Carl Schmid, executive director of the HIV+Hepatitis Policy Institute.

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