Trump Administration to Review Fewer Health Plans for Drug Coverage; Patient Groups Concerned – Will Patients be Able to Access their Drugs?

Washington, DC – On the same day the Trump Administration issued a “market stabilization” rule that seeks to help the insurance companies stay in the individual market, CCIIO issued guidance to the states that announced it will conduct drug coverage reviews in fewer states.  Instead, CCIIO will rely more on the states to conduct these complicated reviews and to ensure that plan design does not discriminate against patients.

“What we have observed over the past several years is that federal patient protections and robust enforcement are needed to ensure patients have access to the medications they need,” commented Carl Schmid, Deputy Executive Director of The AIDS Institute.  “Left alone, some plans limit coverage, charge high patient cost-sharing, and employ other techniques that constitute discrimination, particularly against those patients with serious and chronic health conditions.  For the ACA to work for patients, we need not only strong patient protections but strong enforcement of the law.”

Some states may have the resources and the tools to conduct these reviews, but most do not.  Instead they have relied on CCIIO’s templates and drug lists to ensure plans are covering the necessary drugs.  CCIIO has also been reviewing for excessive patient cost-sharing and utilization management techniques.

“Enforcement of patient protections is critical for ensuring individuals can access the medications they need to manage their conditions.  As a national organization with an active presence in the states, we appreciate the importance of state regulation. However, many states simply do not have the laws and regulations in place to protect patients against bad practices,” commented Beatriz Duque Long, Senior Director of Government Relations for the Epilepsy Foundation.

Earlier this year, the I Am Essential coalition sent a letter signed by 200 patient groups urging Health and Human Services Secretary Tom Price to maintain and enforce critical patient protections and meaningful access to prescription drugs when reviewing and suggesting changes to the ACA.

“Neither patient groups nor anyone else from the public was able to comment on this new guidance,” added Duque Long.  “We remain concerned that patient protections will be weakened if the Administration is not diligent about enforcement, but remain committed to working with Secretary Price to ensure meaningful access to prescription medications for individuals who rely on ACA Marketplace plans regardless of what state they live in.”

Representatives of I Am Essential have requested to meet with officials of the Trump Administration and hope to personally relay the concerns of patients in the near future.


The “I Am Essential” Coalition is a broad group of patient and community organizations representing millions of patients and their families. The Coalition strongly supports access and coverage for the healthcare needs of individuals living with chronic conditions and disabilities. I Am Essential works to ensure health plans provide quality and affordable Essential Health Benefits and to strengthen patient protections in the evolving health care landscape.

Media Contact
Carl Schmid(202) 669-8267

For Media Inquiries, please contact Carl Schmid of The AIDS Institute.



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