Obamacare Covers Breast Cancer Prevention Meds

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

CHICAGO, IL - FEBRUARY 13: Health and Human Services Secretary Kathleen Sebelius speaks during a press conference at the Erie Family Health Center on February 13, 2013 in Chicago, Illinois. Sebelius, with Illinois Governor Pat Quinn, used the opportunity to promote cooperation between states and the federal government in the implementation of the Affordable Care Act. (Photo by Scott Olson/Getty Images)
National Journal
Sophie Novack
Jan. 9, 2014, 10:41 a.m.

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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