Amendment to Section 1927 of the SSA Act regarding
Medicaid Payments for Covered Outpatient Drugs

A Federal Legislative Solution to Improving
Medicaid Coverage of Rare Disease Therapies
Jay Greissing
Dir., U.S. Gov’t Relations and Public Policy
Our purpose
We enable people with life-altering conditions to lead better lives.
September 19, 2014

Medicaid Coverage Restrictions
Step Therapy
• Alaska
• Arkansas
• California
• Georgia
• Minnesota
• Oregon – Section 1115 Waiver to establish Prioritized Health Services List
To be as brave as the people we help.
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Solution
• Prohibit Medicaid plans from using restrictive step therapy protocols when:
• The drug is prescribed for a rare disease; and
• The rare disease is an FDA approved use
To be as brave as the people we help.
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Why Should The Community Partner to Petition Congress?
• E quity for individuals w/ rare conditions
• P hysician and patient preference
• I nnovation of and access to individualized treatments
• C ontinuity of care
To be as brave as the people we help.
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