This presentation reviewed the Commission’s work on high-cost specialty drugs. In 2020, MACPAC convened a technical advisory panel to discuss the specialty drug pipeline, the challenges these drugs present to Medicaid, and payment and coverage models to address these challenges. In October, staff presented on the results of an analysis on the specialty drug pipeline and the decision in the first panel meeting to focus on drugs receiving accelerated approval, cell and gene therapies, and specialty drugs that treat sensitive populations. The panel met again in November and December to consider specific payment and coverage models, their design parameters, and the potential effect on various stakeholders for the three priority drug groups identified in the first meeting.
The panel narrowed down the options and proposed a differential rebate for drugs receiving accelerated approval and recommended coverage of cell and gene therapies from the Medicaid Drug Rebate Program into a new benefit.