amendment to section 1927 of the ssa act regarding medicaid payments for covered outpatient drugs

Jay Gressing, Shire

Amendment to Section 1927 of the SSA Act regarding Medicaid Payments for Covered Outpatient Drugs

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

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

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.

5

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