NCCS Letter to HHS Highlights “Deep Reservations” Concerning Massachusetts 1115 Waiver

The waiver amendment application from the Commonwealth includes a proposal to adopt a “commercial-style closed formulary with at least one drug available per therapeutic class” for MassHealth. The Commonwealth has not explained why the tools available to it, including a preferred drug list, prior authorization requirements, and rebates, are not adequate for management of drug utilization. Without addressing the adequacy of these tools, the Commonwealth moves to a formulary plan that may adversely affect cancer patients.

Cancer care is often combination therapy incorporating drugs from different drug classes or multiple drugs in a class. In addition, cancer treatment is increasingly targeted according to the patient’s individual profile, often established through molecular testing. An individual patient may receive a clinical benefit from one drug in a class and not another, and a closed formulary may not be responsive to these individual needs. For some cancer patients, the management of the side effects of cancer treatment poses serious medication challenges. We are concerned that the closed formulary proposed by the Commonwealth for MassHealth patients will make it more difficult – if not impossible – for cancer patients to receive the drugs necessary for appropriate treatment therapies for those enrolled in MassHealth.