Following up on MACPAC’s June 2018 recommendations to improve the operation of the Medicaid Drug Rebate Program, the Commission is examining several additional issues related to outpatient prescription drug coverage and pricing. This presentation focuses on state Medicaid programs’ coverage of new drugs and drugs that have disproportionately high costs and complexity. The presentation looks at proposals for a grace period to allow states to develop coverage criteria for new drugs and new payment and rebate strategies for accelerated approval drugs and high-cost drugs.