PBMs

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From the office of Gov. Phil Murphy: Governor Murphy signs legislation bolstering health care affordability and accessibility

Jan 9, 2026

“Patients with HIV, hepatitis, and so many other health conditions rely on copay assistance to afford their drugs. Healthcare is already expensive and when insurers add additional barriers and costs, such as not counting copay assistance towards a patient’s deductible, patients’ costs significantly increase, jeopardizing medication adherence and their health,” said Carl Schmid, Executive Director, HIV+Hepatitis Policy Institute. “We applaud Governor Murphy for signing this bipartisan legislation to put an end to hidden insurer practices that drive up patient costs.”

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Patient groups file amicus brief in imported HIV drug scheme

Jan 2, 2026

“Forcing a person who has employer sponsored health insurance to sign up with an unknown third-party vendor to receive their life-saving drug supplied by a foreign country not only is illegal but jeopardizes the health and safety of patients,” commented Carl Schmid, Executive Director of the HIV+Hepatitis Policy Institute. “In an effort to evade actual coverage of specific prescription drugs that the health insurance plan states it covers, middlemen are profiting by scheming to set up so-called ‘alternative funding programs.’  While federal regulators should be shutting them down, in the meantime, the courts must step in to protect patients.”

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Two years after Court victory, patients still saddled with unaffordable drug costs

Sep 22, 2025

Despite a major court victory nearing two years ago for patients’ ability to afford prescription drugs, the federal government has still not enforced the ruling by requiring insurers to count copay assistance towards patient cost-sharing. Although the Court gave the government the alternative to issue a new clarifying rule relating to drug manufacturer copay assistance and patient cost-sharing, no rule has been proposed two years after the government pledged to the Court and the public that it would.

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Eighty Advocacy Organizations Urge Labor Secretary to Close Harmful EHB Loophole

Apr 22, 2025

The HIV+Hepatitis Policy Institute, along with more than 75 organizations representing patients, providers, and public health advocates, is urging U.S. Secretary of Labor Lori Chavez-DeRemer to issue a promised federal rule that would close a harmful loophole that allows insurers, pharmacy benefit managers (PBMs), and third-party vendors to exploit patient copay assistance programs for financial gain. In a letter sent today, the groups call on the Department of Labor (DOL) to address a gap in the enforcement of the Essential Health Benefits (EHB) provision of federal law—one that enables insurers, PBMs, and third-party vendors to designate certain covered drugs as “non-essential,” evading cost-sharing protections for patients.

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HIV+Hep welcomes new HHS Secretary

Feb 13, 2025

To deliver on the promise of eradicating HIV will require a commitment to science, properly funded public health treatment and prevention programs, and policies that support all populations impacted by HIV.  It will also require access to affordable and comprehensive health coverage, including private insurance, Medicaid and Medicare.

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