63 HIV organizations urge Biden administration to require insurers to cover long-acting PrEP without cost-sharing

“Long-acting PrEP can be the answer to low PrEP uptake, particularly in the communities not using PrEP today. The Biden administration has an opportunity to ensure that people with private insurance can access PrEP now and into the future, free of any cost-sharing, with properly worded guidance to insurers,” commented Carl Schmid, Executive Director of the HIV+Hepatitis Policy Institute. “Poor PrEP uptake among various racial and ethnic groups is an example of failed healthcare decisions of the past. CMS can help correct these inequities by requiring insurers nationwide to cover all FDA-approved PrEP drugs, without burdensome prior authorizations, and begin the vigorous enforcement of ACA protections that has been lacking to date.”

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Federal Government Refuses to Enforce Copay Assistance Court Victory, But Moves to Stop Scheme of Classifying Drugs as “Non-Essential Health Benefits”

“This is nonsense: everyone agrees that patients are having trouble affording their prescription drugs, that copay assistance is helping them, and that the plans are pocketing copay assistance without crediting patients, and even though the rule that allowed insurers not to count that assistance has been struck down, our federal government openly refuses to enforce the court ruling,” commented Carl Schmid, executive director of the HIV+Hepatitis Policy Institute.

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After court victories, HIV+Hep calls on state insurance regulators to enforce copay assistance rule

Unfortunately, since the court ruling nearly six months ago, we continue to hear from patients complaining that insurers are not counting the copay assistance that they receive, and are being saddled with thousands of dollars in unanticipated out-of-pocket costs for their prescription drugs. Some insurers have told their enrollees that they will not enforce the court ruling without regulator action or a court order.

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Federal civil rights office gives pass to insurer for HIV discrimination

“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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With Court victories, patient groups drop appeal in copay assistance case

“Now that the court has struck down the rule that allowed insurers and PBMs not to count copay assistance and clarified that the previous rule—requiring copay assistance to count in most instances—is now in effect, we now must turn to enforcement to ensure patients are no longer being financially harmed by copay accumulators,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, one of the plaintiffs in the lawsuit. “We are already hearing from patients that insurers are still subjecting them to these unscrupulous and now, illegal practices, and we will ensure that any unlawful practices stop.”

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