CMS Rejects Mass. Request to Restrict Medicaid Prescription Drug Coverage

Decision Preserves Patients’ Access to Life-Saving Medications

June 27, 2018

Washington, D.C.—The Centers for Medicare and Medicaid Services (CMS) announced today that they will not approve Massachusetts’ request to restrict Medicaid prescription drug coverage to as few as one drug per class—a practice commonly called a “closed formulary”—unless a state foregoes all manufacturer rebates. Under federal law, Medicaid covers any FDA-approved drug as long as the drug manufacturer complies with the Medicaid discount plan.

A closed formulary would have limited access to prescriptions including cancer drugs for those who get health insurance through the state Medicaid program.

A statement from Chris Hansen, President of the American Cancer Society Cancer Action Network
(ACS CAN) follows:

“Today’s decision is a relief for cancer patients in the Bay State and across the country. Limiting patients’ prescription drug choices to as few as just one drug per class would have posed a serious challenge to millions of low-income cancer patients struggling to manage and treat their disease.

“Prescription drugs have different indications, different side effects and overall efficacy depending on a person’s diagnosis, stage of disease and personal health history. A one-size-fits-all approach would have shifted treatment decisions away from the cancer patient and their doctor.

“As we and more than 100 other groups noted in a joint letter of concern to the Department of Health and Human Services, ‘Patients suffering from chronic, life-threatening conditions need a guarantee of uninterrupted access to the prescription drugs critical to maintaining or treating their disease. Disruptions in the treatment of serious and chronic conditions, including switching a patients’ medication mid-treatment, could negatively impact their treatment and health outcomes.’

“Preserving the ability of Medicaid patients to access the most effective, innovative and potentially life-saving medications is essential to continuing our progress against cancer in our country. We commend CMS for listening to patient concerns when considering this waiver. We will continue to monitor other proposals and urge CMS to similarly reject any that could disrupt access to evidence-based treatments.”

Media Contacts

Allison Miller
Director, Media Advocacy
Washington, D.C.
Alissa Crispino
Vice President, Media and Advocacy Communications
Washington, D.C.