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Health Care

Obamacare Covers Breast Cancer Prevention Meds

HHS issued guidance today clarifying that certain risk-reducing medications are covered in most plans.

HHS Secretary Kathleen Sebelius issued guidance clarifying preventative ACA coverage requirements Thursday.(Scott Olson/Getty Images)

photo of Sophie Novack
January 9, 2014

Certain medications that reduce the risk of breast cancer now must be covered under Obamacare.

The Department of Health and Human Services issued guidance Thursday saying that most insurance plans are required to cover the chemo-preventative drugs tamoxifen and raloxifene without co-pays or out-of-pocket expenses for women with an increased risk of developing breast cancer.

The Obama administration issued the clarification after questions arose about whether these medications count as preventative care, HHS Secretary Kathleen Sebelius and Florida Democratic Rep. Debbie Wasserman Schultz—a breast cancer survivor—wrote in a blog post Thursday.

 

The United States Preventive Services Task Force, an independent panel of experts selected by HHS, revised its recommendation in September to suggest the medications be available to women at high risk for the disease.

There is an exception to HHS' policy, however: Grandfathered plans—those that existed prior to the passage of the Affordable Care Act—are not subject to the same requirements.

The National Cancer Institute estimates that in 2013 there were 232,340 new cases of breast cancer in women, and 2,240 in men. Cause and prevention of breast cancer in men is currently less well understood.

Preventative screening is a point of emphasis for the Affordable Care Act, as the law aims to promote such treatments in a bid to cut total health spending. But what treatments and medications meet the law's criteria for preventative care—and which ones get an inclusion mandate in insurance plans—is a point of contention for various medical constituencies trying to get their treatments under Obamacare's umbrella.

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