Current through Register Vol. 49, No. 9, September, 2024
12. Prescribed drugs, dentures and prosthetic
devices; and eyeglasses prescribed by a physician skilled in diseases of the
eye or by an optometrist a. Prescribed Drugs
(1) Each recipient age 21 or older may have
up to six (6) prescriptions each month under the program. The first three
prescriptions do not require prior authorization. The three additional
prescriptions must be prior authorized. Family Planning, tobacco cessation and
EPSDT prescriptions do not count against the prescription limit.
(2)
Effective January 1, 2006, the
Medicaid agency will not cover any Part D drug for full-benefit dual eligible
individuals who are entitled to receive Medicare benefits under Part A or Part
B.
(3)
The Medicaid
agency provides coverage, to the same extent that it provides coverage for all
Medicaid recipients, for the following excluded or otherwise restricted drugs
or classes of drugs, or their medical uses - with the exception of those
covered by Part D plans as supplemental benefits through enhanced alternative
coverage as provided in
42
C.F.R. §
423.104(f) (1) (ii)
(A) - to full benefit dual eligible
beneficiaries under the Medicare Prescription Drug Benefit - Part D.
The following excluded drugs, set forth on the Arkansas
Medicaid Website (www.medicaid.state.ar.us/InternetSolution/Provider/pharm/scripinfo.aspx#1927d),
are covered:
a.
select
agents when used for weight gain: Androgenic Agents
b.
select agents when used for the
symptomatic relief of cough and colds: Antitussives; Antitussive-Decongestants;
Antitussive-Expectorants
c.
select prescription vitamins and mineral products, except prenatal
vitamins and fluoride: B 12; Folic Acid
d.
select nonprescription drugs:
Antiarthritics; Antibacterials and Antiseptics;
Antitussives; Antitussives-Expectorants; Analgesics; Antipyretics; Antacids;
Antihistamines; Antihistamine-Decongestants; Antiemetic/Vertigo Agents;
Antimalarial; Diabetic Therapy; Electrolytes and Miscellaneous Nutrients;
Emollients; Fat Soluble Vitamins; Gastrointestinal Agents; General Inhalation
Agents; Hematinics; Laxatives; Opthalmic Agents; Respiratory Aids;
Sympathomimetics; Topical Antibiotics; Topical Antifungals; Topical
Antiparasitics; Vaginal Antifungals;
e.
select agents when used to promote
smoking cessation: Nicotine Gum; Nicotine Patches; Generic
Zyban
f.
all
barbiturates
g.
all
benzodiazepines
(4) The State will reimburse only for the
drugs of pharmaceutical manufacturers who have entered into and have in effect
a rebate agreement in compliance with Section 1927 of the Social Security Act,
unless the exceptions in Section 1902(a)(54), 1927(a)(3) or 1927(d) apply. The
State permits coverage of participating manufacturers' drugs, even though it
may be using a formulary or other restrictions. Utilization controls will
include prior authorization and may include drug utilization reviews. Any prior
authorization program instituted after July 1, 1991 will provide for a 24-hour
turnaround from receipt of the request for prior authorization. The prior
authorization program also provides for at least a 72 hour supply of drugs in
emergency situations.
