2001 Session

Budget Amendments - HB1600 (Member Request)

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Chief Patron: Morgan
Medicaid Coverage of Weight Loss Drug Therapies (language only)

Item 319 #24h

Item 319 #24h

Health And Human Resources
Medical Assistance Services, Department of

Page 320, after line 4, insert:
"XX. The State Plan for Medical Assistance shall be amended pursuant to the Administrative Process Act, §9-6.14:1 et seq., Code of Virginia, allow for coverage of FDA-approved drug therapies and agents for weight loss for recipients who are clinically obese with a body-mass index equal to or greater than 30 kilograms per meter and an underlying commorbidity such as hypertension, diabetes, cardiopulmonary conditions, or sleep apnea that is certified and verified by the treating physician in accordance with the procedures for prior authorization required by the Department of Medical Assistance Services."

(This amendment requires the Department of Medical Assistance Services to amend its regulations governing the coverage of weight-loss drug therapies. Currently, the criteria used by the Department is insufficient to met the disease state management objectives of the program or the needs of patients suffering from obesity. By expanding the criteria for coverage of these drug therapies, the Medicaid program could avoid the costs of treating other diseases that are linked to obesity such as diabetes, hypertension and related complications from these diseases.)