What You Don’t Know About the ACA
Mind the Coverage Gap
Those 6.7 million residents fall into the “coverage gap” created by the states’ decisions to
forgo Medicaid expansion. Because the ACA
was originally designed with the assumption
of an expansion of the Medicaid program,
some adults find themselves in this vulnerable position.
“Depending on the state, there could be
people who make too much to qualify for
Medicaid, but not enough to qualify for mar-
ketplace subsidies,” explained Johanna Gray,
MPA, vice president at Cavarocchi, Ruscio,
Dennis Associates, a government relations
and public policy consulting firm.
Here is the dilemma in states where Medicaid expansion did not occur: The median
Medicaid eligibility limits include childless
adults at 0 to 44 percent of the FPL ($8,840
for parents in a family of three). At the other
end of the spectrum, the ACA marketplace
subsidies kick in at 100 to 400 percent of the
FPL ($11,770 to $47,080 for an individual).
That leaves people whose incomes fall
into 45 to 99 percent of the FPL, an estimated 4 million adults according to the
Kaiser Family Foundation’s analysis of 2014
Medicaid eligibility levels, in the coverage
gap (FIGURE 2).6
From a practical standpoint, how would
this affect a patient in the coverage gap? “In
dollar amounts, if you are a parent with two
children and work more than 18 hours a
ELOCTATE
THE FIRST AND ONLY rFVIII
WITH A PROLONGED HALF-LIFE
5 DAYS WITH
FACTOR LEVELS ABOVE 1%
Mean Plasma FVIII Activity (IU/dL)
MEAN FACTOR ACTIVITY PROFILE
AFTER A SINGLE DOSE (50 IU/kg)†
MEAN FACTOR ACTIVITY PROFILE AFTER A SINGLE DOSE (50 IU/kg)*
100
50
MEAN TERMINAL HALF-LIFE
AFTER A SINGLE 5O IU/kg
DOSE IN ADULTS*†
10
5
19.7
HOURS
(17.4, 22.0)
ABOVE
1
0
20
40
60
80
Time (Hours)
100
120
Mean terminal half-life after a single 50 IU/kg
dose in pediatric and adolescent patients*†‡
• 16.4 (14.1, 18.6) hours in subjects 12 to 17 (n=11)
• 14.6 (11.5, 17.7) hours in subjects 6 to 11 (n=27)
• 12.0 (9.55, 14.4) hours in subjects 2 to 5 (n=10)
1%
*The pharmacokinetics of ELOCTATE were evaluated following a
single dose of 50 IU/kg in the Phase 3 study of 28 adults and 11
adolescent, previously treated patients (ages 12 to 17 years), and in
an open-label, multicenter study of 37 pediatric, previously treated
patients (ages 2 to 5 years and 6 to 11 years).
†
Presented in arithmetic mean (95% CI).
‡
Compared to adults and adolescents, clearance was higher in
children 2 to 5 years of age, indicating a need for dose adjustments.
For patients 6 years and older, dose adjustment is not required.
Selected Important Safety Information
• Hypersensitivity reactions, including anaphylaxis, are possible with ELOCTATE. Immediately
discontinue ELOCTATE and initiate appropriate treatment if hypersensitivity reactions occur
Please see Brief Summary of full Prescribing Information on the following pages.
This information is not intended to replace discussions with your healthcare provider.