A. The
Division of Medicaid does not cover pharmacy benefits for full benefit, dual
eligible individuals who are entitled to receive Medicare benefits under Part
A, B, or C, except for drugs in the Medicare excluded categories.
B. Medicaid excluded or otherwise restricted
drugs include, but are not limited to:
1.
Drugs when used for anorexia, weight loss, or weight gain, except selected
drugs used to treat obesity.
2.
Drugs when used to promote fertility,
3. Drugs when used for cosmetic purposes or
hair growth,
4. Over-the-counter
(OTC) items except those listed on the Division of Medicaid's OTC formulary
which are assigned an appropriate National Drug Code (NDC) on their label and
are manufactured by a company that has signed a rebate agreement,
5. Drugs when used for the symptomatic relief
of cough and colds except for cough and/or cold drugs listed on the OTC
formulary and benzonatate,
6.
Prescription vitamins and mineral products except for:
a) Prenatal vitamins,
b) Folic acid, and
c) Cyanocobalamin (vitamin B12)
injections.
7. Covered
outpatient drugs which the manufacturer requires, as condition of sale, that
associated tests or monitoring services be purchased exclusively from the
manufacturer or its designee,
8.
Those drugs designated less than effective by the Federal Drug Administration
(FDA) as a result of the Drug Efficacy Study Implementation (DESI) program
unless provided through expanded EPSDT services in Miss. Admin. Code Part
223.
9. [Deleted eff.
01/01/2014],
10. [Deleted eff.
01/01/2014],
11. Drugs when used
for the treatment of sexual or erectile dysfunction, unless such drugs are used
to treat a condition, other than sexual or erectile dysfunction, for which the
drugs have been approved by the FDA.
12. Drugs that are investigational or
approved drugs used for investigational purposes,
13. Drugs used for off-label indications
which are not found in official compendia or generally accepted in peer
reviewed literature,
14. Drugs
dispensed after the expiration date,
15. Drugs classified as herbal and/or
homeopathic products,
16. Moved to
Miss. Admin. Code Part 214, Chapter 1, Rule
1.3.C,
17. Drugs produced by manufacturers that do
not have signed rebate agreements with the federal government as required by
the Omnibus Budget Reconciliation Act (OBRA) of 1990, unless provided through
expanded EPSDT services in Miss. Admin. Code Part 223, and
18. Compounded prescriptions except for
hyperalimentation. The Division of Medicaid defines compounded prescriptions as
mixtures of two or more ingredients.
C. The Division of Medicaid does not
reimburse for the cost of shipping or delivering drugs.
Patient
Protection and Affordable Care Act,
Pub. L. No.
111-148,
§
2502, 124 Stat . 119 (2010), as amended by
Pub. L.
111-152, 124 Stat. 1029 (2010); Social Security
Act §§ 1927(d)(2)(7); 1935(d)(1)(2);
42 CFR §§
423.100,
423.772,
423.906(c);
42 U.S.C. §§
1396r-8(a),
1396r-8(d); SPA
14-011; Miss. Code Ann. §
43-13-121.
