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Amendment to Section 1927 of the SSA Act regarding Medicaid Payments for Covered Outpatient Drugs.
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Transcript of Amendment to Section 1927 of the SSA Act regarding Medicaid Payments for Covered Outpatient Drugs.
![Page 1: Amendment to Section 1927 of the SSA Act regarding Medicaid Payments for Covered Outpatient Drugs.](https://reader034.fdocuments.in/reader034/viewer/2022051621/56649c935503460f9494f5dd/html5/thumbnails/1.jpg)
Jay Gressing, Shire
Amendment to Section 1927 of the SSA Act regarding Medicaid Payments for Covered Outpatient Drugs
![Page 2: Amendment to Section 1927 of the SSA Act regarding Medicaid Payments for Covered Outpatient Drugs.](https://reader034.fdocuments.in/reader034/viewer/2022051621/56649c935503460f9494f5dd/html5/thumbnails/2.jpg)
Our purpose
We enable people with life-altering conditions to lead better lives.
A Federal Legislative Solution to Improving Medicaid Coverage of Rare Disease Therapies
Jay Greissing
Dir., U.S. Gov’t Relations and Public Policy
September 19, 2014
![Page 3: Amendment to Section 1927 of the SSA Act regarding Medicaid Payments for Covered Outpatient Drugs.](https://reader034.fdocuments.in/reader034/viewer/2022051621/56649c935503460f9494f5dd/html5/thumbnails/3.jpg)
To be as brave as the people we help.
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Medicaid Coverage Restrictions
Step Therapy
• Alaska• Arkansas• California• Georgia• Minnesota
Denial
• Oregon – Section 1115 Waiver to establish Prioritized Health Services List
![Page 4: Amendment to Section 1927 of the SSA Act regarding Medicaid Payments for Covered Outpatient Drugs.](https://reader034.fdocuments.in/reader034/viewer/2022051621/56649c935503460f9494f5dd/html5/thumbnails/4.jpg)
To be as brave as the people we help.
4
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
![Page 5: Amendment to Section 1927 of the SSA Act regarding Medicaid Payments for Covered Outpatient Drugs.](https://reader034.fdocuments.in/reader034/viewer/2022051621/56649c935503460f9494f5dd/html5/thumbnails/5.jpg)
To be as brave as the people we help.
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Why Should The Community Partner to Petition Congress?
• Equity for individuals w/ rare conditions
• Physician and patient preference
• Innovation of and access to individualized
treatments
• Continuity of care