|
Last week, the Department of Health and Human Services (HHS) finalized policies that seek to advance protections against discrimination in health care, including by health plans. CSRO filed comments when the proposed rule was issued in Summer 2022, expressing concern about the Self-Administered Drug (SAD) Exclusion List policies, noting that they are discriminatory against patients who are unable to self-administered due to physician, behavioral or other disabilities. The final rules do not specifically address the SAD list, but acknowledge that “coverage of prescription drugs could pose concerns of prohibited discrimination and OCR would investigate such practices under the rule on a case-by-case basis.”
As we’ve recently shared, due to CSRO leadership and advocacy on this issue, the Centers for Medicare and Medicaid Services (CMS) issued a request for information and announced plans to address the SAD List in future rulemaking, likely as part of the Medicare physician fee schedule (PFS).
Also of importance, when it comes to prescription drug formularies, HHS acknowledged that “[b]enefit design practices related to prescription drugs have an enormous impact on individuals’ access to medically necessary medication” and noted that “[c]overage of prescription drugs could pose concerns of prohibited discrimination and OCR would investigate such practices under the rule on a case-by-case basis.” This policy applies to both pharmacy benefit and medical benefit drugs.
| 
