|
View in browser |
Distributed by Center for Medicaid and CHIP Services (CMCS)
|
|
|
|
Today,
CMS wants to remind states that effective October 1, 2020, state Medicaid
programs are required to provide coverage of Medication Assisted Treatment
(MAT) services and drugs under a new mandatory benefit. The SUPPORT Act of
2018 (P.L. 115-271) amended the Social Security Act (the Act) to add this
new mandatory benefit. The purpose of the new mandatory MAT benefit
found at section 1905(a)(29) of the Act is to increase access to
evidenced-based treatment for Opioid Use Disorder (OUD) for all Medicaid beneficiaries
and to allow patients to seek the best course of treatment and particular
medications that may not have been previously covered.
CMS
interprets sections 1905(a)(29) and 1905(ee) of the Act to require that, as
of October 1, 2020, states must include as part of the new MAT mandatory
benefit all forms of drugs and biologicals that the Food and Drug
Administration (FDA) has approved or licensed for MAT to treat OUD.
More specifically, under the new mandatory MAT benefit, states are required
to cover such FDA approved or licensed drugs and biologicals used for
indications for MAT to treat OUD. States currently cover many of
these MAT drugs and biologicals (for all medically-accepted indications)
under the optional benefit for prescribed drugs described at section
1905(a)(12) of the Act.
The
President has signed H.R. 8337, the Continuing Appropriations Act, 2021 and
Other Extensions Act. This new law made a statutory change to Section
1905(a)(29) and 1905(ee) of the Act, and now clarifies that MAT drugs when
used for OUD as described under the mandatory benefit are deemed prescribed
drugs, and covered outpatient drugs subject to section 1927 of the Act
requirements, as appropriate.
Specifically,
these amendments to the Act ensure a state’s ability to seek section 1927
drug manufacturer rebates, and apply drug utilization management
mechanisms, such as preferred drug lists and prior approval, and a
manufacturer’s duty to pay appropriate rebates and comply with all
applicable manufacturer drug product and drug pricing reporting and payment
of rebates. The change in law is effective as of the date of enactment of
the original SUPPORT Act, which was October 24, 2018. Further CMS guidance
will be forthcoming on other implementation issues relating to this new
mandatory MAT benefit.
|
|
Stay connected with Medicaid.gov and CMS:
No comments:
Post a Comment