States must navigate a complicated landscape of drug purchasing and reimbursement. To help states innovate, the State Medicaid Alternative Reimbursement and Purchasing Test for High-Cost Drugs (SMART-D) initiative was launched in February 2016 with financial support from Arnold Ventures. The initiative seeks to support states in the development of alternative payment models (APMs) for prescription drugs and pharmacy policy interventions.
From 2016 to 2018, SMART-D focused on helping states identify APMs for managing Medicaid prescription drug costs. These APM options were designed to improve access to evidence-based therapies, while helping policymakers predict and manage prescription drug costs in a manner that connects price, payment, value, and health outcomes. Drawing upon international and United States commercial models, Center research identified alternative payment options and existing legal pathways for state Medicaid programs to use when paying for high-cost drugs.
Since 2019, SMART-D efforts have been focused on pharmacy policy interventions, providing research and technical assistance to states in 2 focus areas: multi-payer purchaser partnerships involving Medicaid and other public purchasers; and single and aligned preferred drug lists (PDLs) for Medicaid managed care states.