Amendment to Section 1927 of the SSA Act regarding Medicaid

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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

Denial

• 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 •

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nnovation of and access to individualized treatments •

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ontinuity of care To be as brave as the people we help.

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