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
Add to Briefcase
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.

What We're Following See More »
FBI To Investigate New Clinton Emails
34 minutes ago
TO AIR OCT. 31 & NOV. 1
Stein, Johnson to Participate in PBS Candidate Forum
56 minutes ago

It was announced on Friday that Gary Johnson and Jill Stein will participate in a candidate's forum, to be filmed live on Oct. 31 and air in two parts. The forum will air on PBS's Tavis Smiley. Additionally, there will be a 30 minute discussion available exclusively online with questions selected from social media.

Obama: Michelle Will Never Run for Office
2 hours ago
North Dakota Pipeline Protests Turn Violent
4 hours ago

The protest over the construction of the Dakota Access Pipeline turned violent overnight as the police and National Guard sought to remove the protesters, surrounding them with assault vehicles and officers in riot gear. The law enforcement officers used pepper spray and fired bean bags for more than six hours. In response, the protesters "lit debris on fire and threw Molotov cocktails in retreat." One woman pulled out a gun and fired at officers, narrowly missing before being arrested. The protesters claim the pipeline would be constructed on land belonging to the Standing Rock Sioux Tribe.

House Leadership Elections Slated for Nov. 15
4 hours ago

The House has scheduled leadership votes for Nov. 15, the day after members return from their election recess. "Since mid-September, members of the House Freedom Caucus have weighed whether they should ask leadership to push back the elections so they can see how House Speaker Paul Ryan performs at the end of the year," but leaders don't seem inclined to grant their request.


Welcome to National Journal!

You are currently accessing National Journal from IP access. Please login to access this feature. If you have any questions, please contact your Dedicated Advisor.