STAT+: Medicaid transgender care rule sets precedent that could restrict coverage of other drugs

WASHINGTON — The Trump administration plans to use a new approach to deny Medicaid coverage of drugs for gender-affirming care. The precedent it sets could be used to avoid paying for other drugs, too, upending an expectation that Medicaid covers the vast majority of prescription medication.

The Centers for Medicare and Medicaid Services issued a final rule this month barring the use of federal Medicaid and CHIP funding to pay for pediatric gender-affirming medications and surgery. The rule, set to go into effect Oct. 13, attracted attention because it’s the latest development in the administration’s campaign to halt transgender health care for young people.

But Medicaid experts say the rule could set a precedent for denying coverage of drugs and other services beyond gender-affirming care. In general, Medicaid must cover most outpatient drugs approved by the Food and Drug Administration for medically accepted indications, as long as drug companies agree to pay significant rebates to Medicaid to be part of the program.

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