American Lung Association Urges CMS to Reject Massachusetts Medicaid Waiver Proposal

Statement from American Lung Association National President and CEO Harold P. Wimmer, regarding the Massachusetts Medicaid Demonstration Amendment Waiver:

"The American Lung Association urges the Centers for Medicare and Medicaid Services (CMS) to reject the waiver proposal from Massachusetts' Medicaid program, MassHealth. If this waiver were to be granted, patients would be harmed as a result. 

"In its waiver proposal, Massachusetts asks CMS for permission to limit its drug formularies to one drug per class. This is a dangerous and potentially life-threatening proposal for patients. For example, an asthma patient may need multiple drugs in one class to control their symptoms. Depending on the severity of the patient's asthma, different medications are recommended and in some cases, multiple medications are recommended. Such a policy could also be damaging to lung cancer patients and could prevent them from being treated with the appropriate life-saving targeted therapies or immunotherapy. In order to effectively treat patients, a robust, open formulary needs to be part of the Medicaid program so that patients can access the treatment their doctor believes is best for them.

"MassHealth also proposes to move certain adults from its Medicaid expansion program to the health insurance exchange, ConnectorCare. The Lung Association has concerns that moving this vulnerable population out of Medicaid Expansion will harm patients living with lung disease by increasing their out-of-pocket costs – thereby reducing access to treatments. It would also in practice remove the non-emergency transportation benefit for these patients, preventing them from getting needed treatment.

"Finally, MassHealth has proposed a duplicative drug approval processrequiring any treatment that the Food and Drug Administration finds safe and effective under its expedited review process to be re-reviewed and approved in order to be covered by MassHealth. Requiring a duplicative approval process could mean that MassHealth patients do not have access to the treatments they need to stay alive—including groundbreaking lung cancer treatments that may literally be the difference between life and death for patients.

"The American Lung Association strongly urges CMS to reject this waiver amendment."

For more information, contact:

Allison MacMunn
312-801-7628
[email protected]

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