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Changes Made to States' Medicaid Programs To Ensure Beneficiary Access to Prescriptions During the COVID-19 Pandemic

Why OIG Did This Audit

On March 13, 2020, the President of the United States declared that the COVID-19 pandemic was a national emergency. That same day, in accordance with section 1135(b) of the Social Security Act (the Act), the Secretary of the Department of Health and Human Services invoked his authority to waive or modify certain requirements of Titles XVIII, XIX, and XXI of the Act.

To limit the spread of the virus, Federal, State and local governments urged individuals to stay at home and for individuals who test positive to quarantine, among other preventive measures. As a result, the usual and customary ways that many individuals obtained prescription drugs were altered and access to those prescription drugs reduced.

Our objective was to identify actions that selected States took or planned to take to ensure that Medicaid beneficiaries continued to receive prescription drugs during the COVID-19 pandemic.

How OIG Did This Audit

We designed a questionnaire that sought information on specific policy changes affecting Medicaid beneficiaries' access to prescription drugs during the pandemic. We judgmentally selected 23 States and the District of Columbia (called the "24 States" in our report) to answer our questionnaire regarding actions the States had taken or planned to take to ensure that beneficiaries continued to receive prescription drugs.

What OIG Found

Most States from which we obtained information responded that, as a result of the pandemic, they had implemented changes to ease restrictions on prior authorizations and early refill requirements, made changes to their prescription quantity limits to allow pharmacies to dispense increased quantities of some prescription drugs, and removed the requirement of obtaining a signature upon receipt of a prescription.

In addition, most States from which we obtained information responded that they have implemented changes that give physicians greater flexibility to prescribe drugs to both new and established patients following telehealth episodes during the COVID-19 pandemic. All 24 States in our survey indicated that they are providing updated guidance to all stakeholders to ensure that beneficiaries can obtain their prescriptions.

What OIG Recommends and CMS Comments

We summarized the selected States' actions to share the information with the Centers for Medicare & Medicaid Services (CMS) and States for their use. This report contains no recommendations.

CMS did not have any comments on the draft report.

Filed under: Centers for Medicare and Medicaid Services