On October 1, 2020, the Center for Medicare and Medicaid Services (CMS) reaffirmed that under the SUPPORT Act of 2018, state Medicaid programs are now required to provide coverage of Medication-Assisted Treatment (MAT) services and drugs as a new mandatory benefit. The purpose of the new mandatory benefit is to increase access to evidence-based treatment for Opioid Use Disorder (OUD) for all Medicaid beneficiaries and to allow patients to always seek the best course of treatment for themselves, including any medications that may not have been previously covered.
CMS is interpreting the SUPPORT Act amendments to the Social Security Act to require that, effective October 1, 2020, states must include all forms of drugs and biologicals that the Food and Drug Administration (FDA) has approved or licensed for MAT to treat OUD as part of the new MAT mandatory benefit. Specifically, states are required to cover such FDA-approved or -licensed drugs and biologicals used for indications for MAT to treat OUD. Prior to October 1, 2020, states often covered the MAT drugs and biologicals (for all medically-accepted indications) as an optional benefit for prescribed drugs under the Social Security Act.
Additional Requirements
In addition to the SUPPORT Act, President Donald Trump signed the Continuing Appropriations Act, 2021 and Other Extensions Act, which made a statutory change to the Social Security Act to clarify that MAT drugs used for OUD as described under the mandatory benefit are considered prescription drugs and covered outpatient drugs subject to requirements under the Section 1927 of the Social Security Act.
Specifically, these amendments to the Social Security Act ensure a state’s ability to seek section 1927 drug manufacturer rebates, and apply drug utilization management mechanisms, such as preferred drug lists and prior approval, and a manufacturer’s duty to pay appropriate rebates and comply with all applicable manufacturer drug product and drug pricing reporting and payment of rebates. The change in law is effective as of the date of enactment of the original SUPPORT Act, which was October 24, 2018.
CMS will continue to issue guidance on other implementation issues related to the new mandatory MAT benefit.
The Office of National Drug Control Policy will continue to push for expanded access to MAT and recovery support services, to end the addiction epidemic and save lives.