The Medicaid and CHIP Payment and Access Commission (MACPAC) released its June report to Congress, with chapters focusing on the high cost of prescription drugs and the opioid epidemic.
Medicaid Rebates
The first chapter describes the Medicaid prescription drug policy and its rebate program, which serves as the primary mechanism to reduce state and federal Medicaid drug spending. Specifically, the commission makes two recommendations regarding the program:
- closing a loophole in current law that allows pharmaceutical manufacturers to reduce their rebate obligations; and
- giving the Health and Human Services (HHS) secretary clear authority to impose financial sanctions on manufacturers that misclassify brand name drugs to lower rebate payments.
Privacy Regulations in Substance Use Disorder (SUD) Treatment
Chapter two covers confidentiality regulations and care integration related to individuals with SUD. The chapter reviews the current state of SUD privacy rules, including 42 CFR Part 2 (Part 2) and how it relates to the Health Insurance Portability and Accountability Act (HIPAA). MACPAC recommends that the HHS secretary:
- direct agencies to issue subregulatory guidance to clarify sections of Part 2 for providers; and
- direct a coordinated effort to provide education and technical assistance on Part 2.
Access to SUD Treatment in Medicaid
The final chapter reviews state policies related to access to SUD treatment for Medicaid beneficiaries. The chapter emphasizes the importance of ensuring beneficiaries have access to a variety of SUD treatment options across the continuum of care, including:
- outpatient services;
- intensive outpatient services;
- partial hospitalization;
- residential treatment; and
- medication-assisted treatment.
The report also explores state use of section 1115 waivers to improve SUD care, including waivers of the institutions of mental disease exclusion that currently exists in the Medicaid program.
Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.
