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SPA 18-0011 Physician Administered Drugs (PAD) approved by CMS

State Plan Amendment (SPA) 18-0011 Physician Administered Drugs (PADs) has been approved to allow the Division of Medicaid to reimburse for certain PADs under the pharmacy benefit to improve beneficiary access. These certain PADs are currently referred to as Clinician Administered Drug and Implantable Drug System Devices (CADDs) and include, but are not limited to, long-acting reversible contraceptives (LARCs), pregnancy maintaining agents, injectable atypical antipsychotic agents, and chemical dependency treatment agents. CADDs may be billed as either medical or pharmacy point of sale (POS) claims, effective July 1, 2018.

For more information, read the approved SPA pages.