Asthma Care Coverage Report
The
American Lung Association tracks seven areas of guidelines-based asthma care coverage in state Medicaid programs, including:
- quick-relief medications
- controller medications
- devices (nebulizers, peak-flow meters, valved-holding chambers)
- allergen testing
- immunotherapy
- home visit information
- self-management education
In addition to tracking coverage, the Lung Association tracks nine barriers that can limit access to these seven categories of treatments and services.
- Age Limit: indicates a medication is only covered if a patient is under a certain age.
- Age Restriction: indicates a medication is only covered if a patient is over a certain age.
- Copayment: fee a patient is responsible for in order to get the treatment.
- Durable Medical Equipment (DME): indicates the treatment or medication is only available under the DME benefit.
- Eligibility Criteria: indicates a patient needs to meet certain criteria before the patient receives a treatment or service.
- Prior Authorization: indicates that in order for a patient to receive a treatment or service, it must first be approved by a patient’s plan.
- Quantity Limit: limits the amount of services or medication that a patient can have during a specified amount of time.
- Specialty Visit Limitation: indicates that services can only be accessed through a specialist and specialty visits are limited to a set number during the course of a year.
- Stepped Therapy: indicates that a treatment or service can be received only after other type of therapy has been tried.