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Many Medicaid programs make coverage rare
decisions for therapies without input from diseases,
only 5%
either the public or experts. These have
processes often result in inappropriate treatments
restrictions for vulnerable patients or
even a denial of needed medications.
Following the example set by several states, based on a similar program at the FDA
(EXPERRT Act), and endorsed by the Consumer Representatives to the National
Association of Insurance Commissioners (NAIC), state Medicaid agencies should
incorporate experts into the coverage process:
P&T/DUR Review
Draft Policy
P&T/DUR Vote
Coverage Initiated