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.

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