In 2018, Congress passed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act, P.L.115-271) to help address the nation’s opioid epidemic. As part of this legislation, Congress mandated that Medicaid programs cover all medications used to treat opioid use disorder (MOUD) for a five-year period. In doing so, Congress appears to have created an unintended exclusion from the definition of covered outpatient drug. As a result, MOUDs will no longer be eligible for the statutory Medicaid drug rebates for the next five fiscal years, beginning October 1, 2020. Moreover, states will no longer be required to include MOUDs in drug utilization review (DUR) programs and MOUDs will be excluded from the 340B drug pricing program.
In this presentation, we provide background on the SUPPORT Act and the Medicaid Drug Rebate Program (MDRP). It reviews the definition of covered outpatient drug and how coverage of MOUDs under a new benefit category excludes these products from the MDRP, and how this exclusion affects drug rebates, DUR requirements, and the 340B drug pricing program. Finally, this presentation includes a potential solution to address the unintended exclusion of MOUD from the definition of a covered outpatient drug.