Massachusetts Tries To Limit Medications Covered Under Medicaid

What’s the story?

• Massachusetts has been at the forefront of healthcare laws since 2006, leading the country in their expansion of Medicaid.

• Now, they’re trying to contain costs to cover nearly a third of the state’s population by getting federal permission to limit the medications Medicaid will cover, and drug companies and consumers are pushing back.

What is Massachusetts asking for?

• The state is asking permission from the Trump administration to limit medications covered by Medicaid to one in every therapeutic class, and to eliminate from coverage any drug "with limited or inadequate evidence of clinical efficacy."

• An exceptions process would be available for individuals seeking coverage for medications that might be medically necessary but are not covered by the state-approved list.

• Currently, reports the New York Times, "Medicaid covers nearly all of a company’s prescription drugs if the company agrees to provide deep discounts to Medicaid."

• State officials insist they are trying to leverage their buying power to bring down costs, and that an administration waiver would prove the president’s commitment to driving down drug prices.

Who opposes a waiver, and why?

• Consumer-rights critics fear a waiver would endanger patients who have to take more than one medication in a given therapeutic class to manage chronic disease.

• Drug manufacturers argue that the waiver is "unfair", considering long standing agreements between companies and the government on pricing. They also argue that states establishing their “formularies” to exclude newer drugs undercuts the authority of the Food & Drug Administration.

• The potential waiver is opposed by Health Care for All, a consumer advocacy group in Boston; the American Medical Association; the American Academy of Pediatrics; the American Cancer Society’s Cancer Action Network; the American Diabetes Association; the National Alliance on Mental Illness; and drugmakers including Amgen, Johnson & Johnson, Eli Lilly, Merck, Pfizer and Teva.

Other states, like Arizona, are looking to secure similar waivers. The president’s budget for FY2019, the Times notes, includes "a legislative proposal for a Medicaid demonstration project that would allow five states to “determine their own drug formularies," much as Massachusetts wants to do.”

What do you think?

Do you support a waiver for Massachusetts to limit and negotiate drug prices? Do you think it will drive down drug costs? Do you think the costs to consumers in choice outweigh the benefits? Is a waiver "unfair" to drug companies?

Tell us in the comments what you think, then use the Take Action button to tell your reps!

Take Action

— Asha Sanaker

(Photo Credit: Images Money via Flickr / Creative Commons)