Carl Schmid, Executive Director of the HIV + Hepatitis Policy Institute began the Searching for Savings: An Innovative Approach to Pay for Prescriptions session by sharing the miraculous statistics in HIV and Hepatitis care.
“With HIV, we now have drugs that people take and have access to, and they can lead a healthy life…and now we have medications that can prevent HIV…,” Schmid said. “We now have a cure for hepatitis C. It’s really a miracle, it’s a miracle for the millions of people in the states.”
Schmid discussed the cost structure of prescription medications, bringing to light obstacles facing people paying for prescriptions.
“Fifty-five million people abandoned their therapy in 2020 as out-of-pocket costs increased,” he said.
Schmid explained within deductible, co-insurance and the copay phases of payment, costs could still be too high, creating barriers to fulfilling prescriptions.
Schmid had several successful options for states to provide more opportunities for people to fulfill their prescriptions.
He said drug manufacturers provide copay assistance and he found discrimination against people who rely on prescription drugs or have chronic conditions still exists. He pointed to unnecessary pre-authorizations and policies that have limited transparency.
“Who are the patients that are being impacted by this,” he asked. Schmid said percentages are increasing among cardiology, infectious disease, and other areas of patients in need of assistance.
One effort Schmid and his team, the All Copays Count Coalition, are working toward includes advancing legislation.
“Copay assistance has to count toward a person’s out-of-pocket deductible,” he said. “Twelve states and Puerto Rico have passed laws that say yes to that.”
Schmid said he was able to successfully partner with the Trump Administration to get the copay assistance to count in most situations, only to have it suspended in 2019 due to an IRS exception with Health Savings Account. To date, the annual notice of benefit and payment parameters rule has gone back and forth with the change in administrations. He says he remains hopeful that in 2023 this issue will be addressed at the executive level.