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
- home visit information
- self-management education
See Michigan’s Asthma Care Coverage Report
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.
Learn more about the methodology and sources used to create this list, and see other state reports