MAIL Act

To amend title XIX of the Social Security Act to increase the Federal medical assistance percentage under the Medicaid program for States providing certain coverage relating to covered outpatient drugs, and for other purposes. 1. Short title This Act may be cited as the Medication Access Improves Lives Act MAIL Act 2. Increase in Medicaid FMAP for States providing certain coverage relating to covered outpatient drugs (a) In general Section 1905(b) of the Social Security Act ( 42 U.S.C. 1396d(b) Beginning April 1, 2020, in the case of a State that provides medical assistance for covered outpatient drugs (as defined in section 1927(k)), including such drugs dispensed by a mail order pharmacy, the Federal medical assistance percentage determined under this subsection (and subsections (y) and (ff) (as applicable)) shall be increased by 1 percentage point with respect to medical assistance for such drugs, but in no case may such percentage exceed 100 percent for such medical assistance. (b) Conforming amendments Section 1905 of the Social Security Act ( 42 U.S.C. 1396d (1) in subsection (y)(1), by inserting after Notwithstanding subsection (b) (but subject to the sixth sentence of such subsection (relating to a Federal medical assistance percentage increase with respect to medical assistance for covered outpatient drugs)) (2) in subsection (ff), by inserting after Notwithstanding subsection (b) (but subject to the sixth sentence of such subsection (relating to a Federal medical assistance percentage increase with respect to medical assistance for covered outpatient drugs)) 3. Requiring States that provide medical assistance for covered outpatient drugs to allow for up to 3-month supply of fills and refills of such drugs Section 1927(a) of the Social Security Act ( 42 U.S.C. 1396r–8(a) (8) Requirement to allow for up to 3-month supply of fills and refills (A) In general In order for payment to be available under section 1903(a) for a covered outpatient drug that is administered on or after the first day of the first full month following the date of the enactment of this paragraph, the State shall permit any individual enrolled under the State plan (or a waiver of such plan) to obtain in a single fill or refill, at the option of such individual, the total day supply (not to exceed a 90-day supply) prescribed for such individual for a covered outpatient drug, without regard to any cost and utilization management, medication therapy management, or other such program that would otherwise apply under such plan (or waiver). (B) Safety edit The State may not permit an individual enrolled under the State plan (or a waiver of such plan) to obtain a single fill or refill of a covered outpatient drug under such State plan (or waiver) if such fill or refill would be inconsistent with an applicable safety edit under such plan (or waiver). .

Summary: Medication Access Improves Lives Act or the MAIL Act This bill increases the Medicaid Federal Medical Assistance Percentage (FMAP) for covered outpatient drugs, including mail-order drugs, beginning April 1, 2020. The bill's increase may not result in an FMAP greater than 100%. Additionally, Medicaid enrollees must be allowed to obtain the entire prescribed supply of a covered outpatient drug in a single fill or refill, up to a 90-day supply.