Insurance coverage

Working to fill gaps in insurance coverage for preventive care

Across the US population, gaps in health insurance coverage cause people to miss opportunities to achieve optimal health.

The WADA House of Delegates taken steps to close three of these gaps in the 2022 WADA Interim Meeting will be held this week in Honolulu.

Medicare coverage rules vary between vaccines as well as Parts B and D, and these differences can pose significant barriers to vaccination. In addition, administrative hurdles exist because it can be difficult for medical practices to contract with multiple individual Medicare Part D plans, according to a resolution presented at the meeting by the AMA Senior Physicians Section.

To ensure that Medicare beneficiaries receive all the vaccines they need, delegates asked the AMA to advocate “that Medicare cover the full cost of all vaccinations given to Medicare patients that are recommended by the Committee.” Advisory on Immunization Practices (ACIP) at the point of care and outside of budget neutrality requirements.

Visit WADA Advocacy in Action to know more what are the challenges of covering the uninsured and other advocacy priorities that WADA is actively working on.

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Pre-exposure prophylaxis (PrEP) for HIV is essential to ending the HIV epidemic in the United States, yet only 25% of the estimated 1 million Americans most at risk of infection use it. Use is further hampered by a recent Federal Court ruling that Affordable Care Act (ACA) coverage of PrEP cannot be made mandatory because it is against the restoration of religious freedom, according to a resolution presented by the AMA Physician Integrated Practice Section.

To help ensure access to HIV prevention, the House of Delegates asked WADA to:

  • Support the continued inclusion of PrEP for HIV as an essential preventive health benefit as part of the ACA.
  • Support and join legal efforts to overturn the judgment rendered in Braidwood vs. Becerra in the United States District Court for the Northern District of Texas.

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Several anti-obesity drugs have now been approved by the Food and Drug Administration for use in children, greatly expanding the options for safe and effective pharmacological options for the treatment of pediatric obesity.

But many health insurance plans, public and private, fail to adequately cover lifestyle therapy, anti-obesity medications, and metabolic and bariatric surgery, resulting in progressive weight gain and weight-related comorbidities. , according to a resolution presented by the American Academy of Pediatrics. and the Obesity Medicine Association.

To address the issue, delegates amended the existing policy, stating that the AMA “is working with interested national medical specialty societies and state medical associations to increase public insurance coverage and payment of full range of evidence-based adult and pediatric obesity treatments”.

Read about each other highlights from the 2022 AMA Mid-Meeting.