The Medicaid Act provides broad coverage for prescription drugs. However, access challenges persist, including prior authorization, cost sharing, prescription limits, state efforts to restrict coverage for off-label uses, and unlawful coverage denials. NHeLP works with state and federal partners to ensure that Medicaid enrollees can obtain the prescription drugs they need and to oppose efforts to reduce prescription drug access and coverage in Medicaid. Our work also extends to protecting access to medically necessary over-the-counter prescription medications.
NHeLP is also leading efforts to improve prescription drug coverage in ACA-regulated plans. NHeLP first identified the discriminatory practice of “adverse tiering,” whereby insurers place all drugs used to treat a condition, like HIV, in the highest cost sharing tiers. Ongoing priorities include combatting discriminatory benefit design, bolstering cost sharing protections, ensuring consumer access to non-formulary drugs, and improving prescription drug coverage standards.
