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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