Under the Medicaid program, states receive large rebates from drug manufacturers, but in exchange, must cover essentially all prescription drugs. This coverage requirement creates challenges for states to manage drug spending, particularly with the introduction of new, high-cost drugs. MACPAC invited Dr. Rebekah Gee, Secretary of the Louisiana Department of Health, and Dr. Paul Jeffrey, Director of Pharmacy for MassHealth (Massachusetts Medicaid) to discuss the innovative coverage and payment policies their states are pursuing. Dr. Gee presented on Louisiana’s subscription model to pay for curative hepatitis C drugs, and Dr. Jeffrey spoke about Massachusetts’s recent Section 1115 waiver request and how the state pays for cell and gene therapies. No slides are available from Dr. Gee’s presentation.