OK SPA 24-0009 and APA WF # 24-12 – Medication Limits
The Oklahoma Health Care Authority (OHCA) will seek approval of a State Plan amendment and rule revisions to remove the list of medications exempt from the medication limits policy, as the list will be hosted on the OHCA website instead. The State Plan amendment and accompanying rule revision are intended to streamline the process of adding new exemptions. New exemptions will be approved by a committee including representatives from the Pharmacy and Finance divisions before being posted online.
Please view the draft SPA here: OK SPA #24-0009 and the draft rules here: APA WF # 24-12 and submit feedback via the comment box.
Tribal Consultation: 3/5/2024
Circulation Date: 2/23/2024
Comment Due Date: 3/24/2024
SPA Effective Date: 4/1/2024, Contingent Upon CMS Approval
Rules Effective Date: Upon Governor’s Approval
Submit a Comment
After you submit your comment, you should be re-directed to a confirmation page. If you are not, please submit your comment through e-mail to federal.authorities@okhca.org.
Please note that all comments must be reviewed and approved prior to posting. Approved comments will be posted Monday through Friday between the hours of 7:30 a.m. – 4 p.m. Any comments received after 4 p.m. will be posted on the following business day.
Comments
Ramon Gardenhire:
On behalf of ViiV Healthcare (ViiV), I am pleased to submit the following comments to the Oklahoma Health Care Authority (OHCA).
ViiV supports OHCA’s current policy of exempting HIV treatment from counting toward medication limits for categorically needy adults. HIV remains a significant public health challenge in Oklahoma, where nearly 7,000 people with HIV were living in 2021.
Among people with HIV in Oklahoma, only 6 in 10 are virally suppressed—meaning that the virus has been reduced to a level undetectable with standard tests. Viral suppression improves morbidity and mortality, reduces costly medical interventions, and prevents transmission. To achieve viral suppression, a person with HIV needs to receive and maintain effective HIV treatment, which is why the state exemption of HIV treatment toward the medication limit for categorically needy adults is critical and must be maintained in the transition to hosting the exemption list on OHCA’s website.
In addition, ViiV encourages OHCA to consider all forms of HIV pre-exposure prophylaxis (PrEP), including oral and long-acting injectables, under the forthcoming streamlined exemption consideration process.
OHCA Response:
Thank you for your feedback.
