Fast Facts Medicaid programs that cover prescription drugs are generally required to cover drugs that are (1) FDA approved and (2) made by a manufacturer that participates in the Medicaid Drug Rebate Program. 13 Medicaid programs didn’t cover Mifeprex and its generic equivalent, Mifepristone Tablets, 200 mg, when required. These drugs are used for medical abortion. We recommended the Centers for Medicare & Medicaid Services ensure Medicaid programs comply with federal requirements for covering Mifepristone Tablets, 200 mg. We also reiterated our 2019 recommendation on Mifeprex, which hasn’t been implemented. White pills spilling from a pill bottle. Skip to Highlights Highlights What GAO Found Medicaid programs that choose to cover outpatient prescription drugs are required to cover all Food and Drug Administration (FDA) approved drugs for their medically accepted indications when those drugs are made by a manufacturer that participates in the Medicaid Drug Rebate Program (MDRP), except as outlined in federal law. The FDA has approved two drugs—Mifeprex in 2000 and its generic equivalent in 2019, referred to as Mifepristone Tablets, 200 mg—for the medical termination of an intrauterine pregnancy, known as a medical abortion. Danco Laboratories and GenBioPro are the exclusive manufacturers of Mifeprex and Mifepristone Tablets, 200 mg, respectively, and both manufacturers participate in the MDRP. Medicaid programs in all 50 states, the District of Columbia, and Puerto Rico cover prescription drugs and participate in the MDRP. According to officials from the Centers for Medicare & Medicaid Services (CMS)—the federal agency within the Department of Health and Human Services (HHS) responsible for ensuring Medicaid programs’ compliance—none of the MDRP’s statutory exceptions apply to Mifeprex or Mifepristone Tablets, 200 mg. Thus, these 52 Medicaid programs must cover these drugs when prescribed for medical abortion in circumstances eligible for federal funding, such as when the pregnancy is the result of rape or incest. GAO identified gaps in Medicaid programs’ coverage of Mifeprex and Mifepristone Tablets, 200 mg. Officials from 35 of the 49 programs who responded to GAO questions said their programs covered Mifeprex and Mifepristone Tablets, 200 mg for medical abortion, as of December 31, 2024. In contrast, officials from 13 programs told GAO their programs did not cover either drug for medical abortion. An official from the remaining program did not specify the medical indications for which its program covered the drugs. Medicaid Programs’ Coverage of Danco Laboratories’ Mifeprex and GenBioPro’s Mifepristone Tablets, 200 mg, as of December 31, 2024 Note: For more details, see fig. 1 in GAO-25-107911. State officials’ responses to GAO’s questions indicated that some states may not be complying with the MDRP requirements for covering Mifeprex and Mifepristone Tablets, 200 mg. However, CMS has not determined the extent to which states comply with the MDRP requirements for these drugs. CMS officials told GAO they were not aware of the following: Nine programs did not cover Mifeprex and Mifepristone Tablets, 200 mg for any medical indication, as of December 31, 2024; GAO reported four of these programs did not cover Mifeprex in 2019. Mifepristone Tablets, 200 mg was not available at the time of GAO’s 2019 report. Four additional Medicaid programs did not cover either drug when prescribed for medical abortion, as of December 31, 2024. CMS was not aware of these coverage gaps, in part, because it had not implemented GAO’s 2019 recommendation to take actions to ensure Medicaid programs comply with MDRP requirements to cover Mifeprex. CMS also has not taken actions related to the coverage of Mifepristone Tablets, 200 mg, as of August 2025. Without such actions, CMS lacks assurance that Medicaid programs comply with MDRP requirements and Medicaid beneficiaries may lack access to these drugs when appropriate. Why GAO Did This Study GAO was asked to describe Medicaid programs’ coverage of mifepristone. This report examines Medicaid programs’ coverage of Mifeprex and Mifepristone Tablets, 200 mg, among other things. GAO reviewed laws and CMS guidance on the MDRP, and coverage of Mifeprex and Mifepristone Tablets, 200 mg. GAO also sent written questions to officials from the 52 Medicaid programs that participate in the MDRP regarding their coverage of these drugs, and reviewed officials’ responses from the 49 programs that provided GAO information. Recommendations GAO reiterates its 2019 recommendation that CMS take actions to ensure states’ compliance with MDRP requirements to cover Mifeprex. GAO also recommends that CMS determine the extent to which states comply with federal Medicaid requirements regarding coverage of GenBioPro’s Mifepristone Tablets, 200 mg, and take actions, as appropriate, to ensure compliance. In response to the recommendation, HHS noted it is reviewing applicable law and will determine the best course of action to address it moving forward. Recommendations for Executive Action Agency Affected Recommendation Status Centers for Medicare & Medicaid Services The Administrator of CMS should determine the extent to which states comply with federal Medicaid requirements regarding coverage of GenBioPro's Mifepristone Tablets, 200 mg, and take actions, as appropriate, to ensure compliance. (Recommendation 1) Open Actions to satisfy the intent of the recommendation have not been taken or are being planned. When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information. Full Report Full Report (11 pages)

A honeybee hive, with its large stores of pollen, wax, and honey, is like a fortress guarding treasure: with strong defenses, but a bonanza for enemies that can overcome those. More than 30 parasites of honeybees are known, spanning protists, viruses, bacteria, fungi, and arthropods – and this number keeps growing. As a result, beekeepers are always on the lookout for new ways to protect their precious hives. A team of researchers from the US suspected that a rich new source of ecofriendly treatments for bee diseases might be hiding in plain sight: in the pollen gathered by bees. They reasoned that so-called endophytes, symbiotic bacteria and fungi living inside most plant tissues, should benefit when their hosts are pollinated. This could be an incentive for these microbes to evolve compounds that keep their host’s pollinators healthy. And now, they have shown their hunch to be correct. “We found that the same beneficial bacteria occur in pollen stores of honeybee colonies and on pollen of nearby plants,” said Dr Daniel May, a faculty member at Washington College in Maryland, US, and the corresponding author of a study in Frontiers in Microbiology. “We also show that these bacteria produced similar antimicrobial compounds that kill pathogens of bees and plants, making them a great starting point for new treatments of crops and hives.” Precious pollen May and colleagues homed in on bacteria from the phylum actinobacteria, the source of two-thirds of the antibiotics currently in clinical use. Between April and June 2021, they collected pollen from 10 native plant species in the Lakeshore Nature Preserve at the University of Wisconsin - Madison. They also collected pollen from the stores of a nearby honeybee hive. The authors isolated 16 strains of actinobacteria from plants, and 18 strains from pollen stores inside the hive. DNA barcoding and genome sequencing revealed that the same or closely related species occurred in both types of samples. The majority (72%) belonged to the genus Streptomyces, the source of many compounds used in medicine and agriculture, for example as antibiotics or as anticancer and antiparasitic drugs. Some of the closest relatives of the Streptomyces species found here are currently under study elsewhere as potential sources of compounds against diseases of crop plants. The authors then conducted ‘competition assays’, where known pathogens were grown together with the Streptomyces isolated here. Nearly all of these proved to be effective inhibitors of the mold Aspergillus niger, which can cause a honeybee disease called stonebrood. Individual strains also proved moderately to strongly active against two bacterial pathogens of honeybees, Paenibacillus larvae and Serratia marcescens, and against three pathogens of crops, Erwinia amylavora, Pseudomonas syringae, and Ralstonia solanaceum. ‘Whisked back to the hive’ “We isolated the same Streptomyces bacteria from flowers, pollen-covered bees leaving flowers, and hives. We conclude from our results that endophytic actinobacteria on pollen grains are picked up by pollinating bees and whisked back to hive pollen stores, where they help to defend the colony against disease,” said May. The authors found clear evidence in the genome of the sequenced species that they were indeed endophytes, rather than living in a loose, haphazard association with plants. They possessed genes encoding enzymes that allow Streptomyces to colonize plant tissue, produce hormones to boost the growth of their host, or scavenge metals around roots. The results confirmed that a great variety of interesting bioactive compounds remain to be discovered in endophytes, many of which could help us to keep honeybees healthy. They also suggest that a landscape rich in plant species is beneficial for bees, as it ensures a greater diversity of actinobacterial endophytes available to them. “In the future, treating bee diseases could be a matter of simply introducing the right beneficial bacteria into hives to help control specific pathogens,” concluded May. Journal Frontiers in Microbiology DOI 10.3389/fmicb.2025.1644842 Method of Research Experimental study Subject of Research Animals Article Title Endophytic Streptomyces from Honeybee Hives Inhibit Plant and Honeybee Pathogens Article Publication Date 30-Sep-2025 COI Statement The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest