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)

Skip to Highlights Highlights What GAO Found Generative artificial intelligence (AI) systems create outputs using algorithms, which are often trained on text and images obtained from the internet. Technological advancements in the underlying systems and architecture, combined with the open availability of AI tools to the public, have led to widespread use. The Department of Veterans Affairs (VA) increased its number of AI use cases between 2023 and 2024. VA has also identified challenges in using AI—such as difficulty complying with federal policies and guidance, having sufficient technical resources and budget, acquiring generative AI tools, hiring and developing an AI workforce, and securing sensitive data. GAO has identified a framework of key practices to help ensure accountability and responsible AI use by federal agencies—including VA—in the design, development, deployment, and continuous monitoring of AI systems. VA and other agencies can use this framework as they consider, select, and implement AI systems (see figure). Figure: GAO’s Artificial Intelligence (AI) Accountability Framework VA’s use of the AI accountability framework along with a solid foundation of IT management and AI use cases could enable the department to better position itself to support ongoing and future work involving the technology. Why GAO Did This Study Developments in generative AI—which can create text, images, audio, video, and other content when prompted by a user—have revolutionized how the technology can be used in many industries, including healthcare, and at federal agencies including VA. AI is a transformative technology for government operations, but it also poses unique challenges because the source of information used by AI systems may not always be clear or accurate. These challenges may be difficult for federal agencies including VA to overcome. In prior reports, GAO found that VA has experienced longstanding challenges in managing its IT projects and programs. This raises questions about the efficiency and effectiveness of its operations and its ability to deliver intended outcomes needed to help advance the department’s mission. GAO’s statement describes (1) VA’s AI use and challenges, and (2) principles and key practices for federal agencies that are considering implementing AI. GAO summarized a prior report that described VA’s use of AI. GAO also summarized key practices for federal agencies and other entities that are considering implementing AI systems. Recommendations The prior GAO reports described in this statement include 26 recommendations to VA concerning management of its IT resources that have not yet been implemented, and one recommendation to update its AI inventory that has not been implemented. Full Report View Full Report Online Highlights Page (1 page) Full Report (18 pages)

image: Populations of Portulaca oleracea on Nishinoshima, an active volcanic island. view more Credit: Tokyo Metropolitan University Tokyo, Japan – Scientists from Tokyo Metropolitan University have determined the genetic lineage of a now extinct plant population from Nishinoshima, a volcanic island whose frequent eruptions periodically “reset” the vegetation. While they traced the lineage to a nearby island, they discovered distinct genetic quirks due to the rarity of seeds making it there, including a “founder’s effect”. Their findings offer a rare glimpse into the very earliest stages of ecosystem development in an isolated environment. Nishinoshima, a part of the Ogasawara Island chain, lies approximately 1000 kilometers south of mainland Tokyo. It is home to regular volcanic activity; a recent series of major eruptions in 2013 destroyed nearly all its vegetation. As devastating as this is for plant life, these periodic “resets” and the sheer remoteness of the island afford scientists a rare glimpse into the early development of ecosystems, as newly arrived genetic material struggles to create a foothold. A team led by Professor Koji Takayama of Tokyo Metropolitan University, formerly affiliated with Kyoto University, has been investigating samples of common purslane, Portulaca oleracea, recovered from the island in 2019, just before an eruption destroyed virtually all flora on the island. While the species itself is found across temperate and tropical climates worldwide, the population on Nishinoshima is now considered extinct. Genetic analysis was carried out on these rare samples, one of 254 individual samples taken from a total of 51 separate populations sampled from all over Japan and Guam. Through careful comparison, the team began to uncover where the population in Nishinoshima came from, and where they lay in the “family tree” (phylogenetic tree) of the species Portulaca oleracea. They looked at both chloroplast DNA and a genome-wide survey of nuclear DNA, assigning families based on genetic similarities. It was found that they were most closely related to populations found in nearby Chichijima, another volcanic island. However, it also became clear that individuals from Nishinoshima had distinct genetic traits. Importantly, they seemed to derive from very few individuals, leading to a strong skew in subsequent genetic divergence. This is known as a founder’s effect. Seeds of common purslane are flat, oblate, and less than a millimeter in size, making it easy for them to disperse via wind, birds, and ocean currents. The team’s analysis, however, showed that opportunities for the plant to survive on the island must have been very limited; the founder’s effect observed in the genetic makeup of the samples was very strong. They also found evidence for genetic drift, where isolated events such as typhoons and volcanic eruptions, not natural selection, are responsible for changes in genetics. The team’s work is a first glimpse into the phylogenetics of a now extinct population. The unique environment of the islands gives scientists a glimpse into the nascent stages of genetic evolution in isolated island environments, from how populations are established via the transport of seeds, to how they survive and thrive. This may also lead to insights into how plant populations are reestablished in the aftermath of natural disasters. This work was supported by KAKENHI (JP23K23945, JP23K20303, JP21KK0131) Grants-in-Aid from the Japan Society for the Promotion of Science (JSPS), the Environment Research and Technology Development Fund (JPMEERF20204006) of the Environmental Restoration and Conservation Agency of Japan, Environmental Surveys by the Ministry of the Environment, and the Eco-LOGIC-al Network Project of The Tokyo Metropolitan Government. Journal Plant Systematics and Evolution DOI 10.1007/s00606-025-01957-y Article Title Origin of populations of Portulaca oleracea on Nishinoshima, an active volcanic oceanic island Article Publication Date 28-Jul-2025