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Author Topic: CMS letter to State Medicaid programs  (Read 6554 times)

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Offline Joe NM

  • Member
  • Posts: 46
CMS letter to State Medicaid programs
« on: November 06, 2015, 05:10:23 pm »
The federal Centers for Medicare and Medicaid Services came out with a very strong letter yesterday to State Medicaid programs advising them that they HAVE to cover these drugs and drop the ridiculous restrictions ('not sick enough,' '6 months of documented abstinence from drug use,' etc.), also that Managed Care Medicaid programs (where your Medicaid is run by a private insurance company) can't make up their own restrictions beyond what the state has already imposed. Hopefully BIG changes are on the way in a lot of states where it's hard to access treatment!

Here's the full text of the letter:
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Prescription-Drugs/Downloads/Rx-Releases/State-Releases/state-rel-172.pdf

And a story from the NY Times about it:
http://www.nytimes.com/aponline/2015/11/05/us/politics/ap-us-hepatitis-drugs.html
HCV Case Manager
Type-1 diabetic
Connoisseur of battling insurance companies, and when that fails resorting to 'Sample Pharmacies' and sneaking insulin back from Mexico to survive.
Kindred spirit/admirer of all on this forum!
Here to help in any way I can!
EVERYONE DESERVES A CURE!

Offline gnatcatcher

  • Member
  • Posts: 1,372
Re: CMS letter to State Medicaid programs
« Reply #1 on: November 06, 2015, 05:24:57 pm »
Thanks, Joe -- hope you saw in the Awareness and Activism forum that Lucinda Porter started a thread about the letter CMS sent to the heads of the pharmaceutical companies that manufacture the current treatments. Glad the CMS is tackling this problem from both angles.
9/29/71 transfusions
HCV genotype 1a
7/09/15-9/30/15 Harvoni

Before treatment:
Viral Load 9,490,582
FibroScan 19.5 kPa [F4]
ALT 262
AST 217
ALP 183

Most recent:
VL still UNDETECTED (SVR 102)
FibroScan 7.6 kPa [F1-2]
ALT 15
AST 20
ALP 85

Offline Joe NM

  • Member
  • Posts: 46
Re: CMS letter to State Medicaid programs
« Reply #2 on: November 06, 2015, 05:43:28 pm »
I just thought to check that section, oops! That's great, I haven't seen a copy of that one yet! Thanks!!!
HCV Case Manager
Type-1 diabetic
Connoisseur of battling insurance companies, and when that fails resorting to 'Sample Pharmacies' and sneaking insulin back from Mexico to survive.
Kindred spirit/admirer of all on this forum!
Here to help in any way I can!
EVERYONE DESERVES A CURE!

 


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