This SPA allows coverage of medically necessary prescribed drugs that are not covered outpatient drugs, including drugs authorized for import by the U.S. Food and Drug Administration (FDA), during drug shortages. Additionally, this SPA authorizes reimbursement of prescribed drugs that are not considered covered outpatient drugs, with the same reimbursement methodologies as covered outpatient drugs.
Due to the government shutdown, updates to information on this website may be limited or delayed. State Medicaid and Children’s Health Insurance Programs (CHIP) continue to operate. Continue to work with the programs in your state to access coverage. For more information about government operating status, visit OPM.gov.