Many of the high-cost specialty drugs in the pipeline, such as cell and gene therapies, require physician administration. As such, physician-administered drugs (PAD) are expected to be a key driver of Medicaid drug spending in the future. To help us examine issues related to PADs, we convened an expert roundtable with federal and state officials, drug payment experts, Medicaid managed care organizations, drug manufacturers, beneficiary advocates, and providers. The purpose of the roundtable was to better understand what strategies states are employing to manage spending on these treatments and determine if policy changes are necessary to help states develop different models for coverage, payment, or rebates that address these challenges.
This session provides background information on how Medicaid policy differs for PADs compared to other drugs dispensed through a pharmacy. We then summarize the themes emerging from the roundtable discussion, including potential strategies for states to address particular challenges in payment and utilization management.