Specialty Drug Coverage and Reimbursement in Medicaid

Medicaid spending on specialty drugs has rapidly increased. There is no standard definition for specialty drugs. They may be expensive; be difficult to handle, monitor or administer; or treat rare, complex or chronic conditions. We will describe States' definitions of, and payment methodologies for, Medicaid specialty drugs and determine how much States paid for specialty drugs. We will also review strategies that States use to manage specialty drug costs, such as formularies, cost sharing, step therapy, and prior authorization.

Announced or Revised	Agency	Title	Component	Report Number(s)	Expected Issue Date (FY)
September 2019	Centers for Medicare & Medicaid Services	Specialty Drug Coverage and Reimbursement in Medicaid	Office of Evaluation and Inspections	OEI-03-17-00430	2021