Patient groups press HHS to revisit ACA drug coverage

In a letter to HHS Secretary Kathleen Sebelius, 14 patient groups said the agency's final rules related to prescription drug coverage under state health exchanges and the Medicaid expansion provision of the Affordable Care Act could restrict patient access to certain drugs.

The letter notes that a "patient's physician should define medical necessity," and that "as currently structured" HHS' final rules allow health plans and not the prescribing physician to determine whether a patient can access "clinically-appropriate medications not on a health plan's formulary." Additionally, the groups said new Medicaid expansion rules would restrict drug access for new beneficiaries compared to current Medicaid guidelines and are a "radical departure from long-standing government policy". The traditional Medicaid program requires states to cover substantially all drugs for which CMS receives a rebate for eligible Medicaid beneficiaries. ...