Medicaid and the Cost of Biomedical Treatments

The lack of proper reimbursement for biomedical therapies under Medicaid is one of the biggest roadblocks to treatment. The lack of a reimbursement structure that allows patients access to treatments and care management services could prove unsafe and ineffective for patients using of biomedical treatments.

One problem that has been identified with the current Medicaid reimbursement structure for biomedicals is “one size fits all” style. The current program does not differentiate between biologic therapies and chemical pharmaceuticals, and specifically does not take into account the extensive extra support services needed to ensure the safe and effective use of biomedicals.

For biomedical treatments to be safe and effective, there are numerous secondary support services that need to be accessible to patients, such as:

• A tracking system to facilitate the receipt and usage of follow-up doses
• A coordinated drug delivery schedule and doctor/patient visit schedule
• Patient counseling

Some patient advocates believe that a revamp of the financial support system for biomedicals is critical. Without a change, they believe that current Medicaid reimbursement systems will result in a lack of adequate compensation and a loss of patient support services which could lead to ineffective course of treatment and unsafe conditions.

The Pros and Cons