Proposed Text
12VAC30-50-35. Requirements relating to payment for covered outpatient drugs for the categorically needy.
A. 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. 1. The
Medicaid agency provides coverage for the following excluded or otherwise
restricted drugs or classes of drugs, or their medical uses to all Medicaid
recipients, including full benefit dual eligible beneficiaries under the
Medicare Prescription Drug Benefit-Part D. The following excluded drugs are
covered:
a. 1. Agents when used for anorexia, weight loss,
weight gain (see specific drug categories in subsection B of this section);
b. 2. Agents when used for the symptomatic relief
cough and colds (see specific drug categories in subsection B of this section);
c. 3. Prescription vitamins and mineral products,
except prenatal vitamins and fluoride (see specific drug categories in
subsection B of this section);
d. 4. Nonprescription drugs (see specific drug
categories in subsection B of this section);
e. 5. Barbiturates, except for dual eligible
individuals when used in the treatment of epilepsy, cancer, or a chronic mental
health disorder (see specific drug categories in subsection B of this
section); and
f. 6. Benzodiazepines, except for dual
eligible individuals as Part D will provide coverage for all conditions
(see specific drug categories in subsection B of this section).
B. Coverage of specific categories of excluded drugs will be in accordance with existing Medicaid policy as described in 12VAC30-50-520.
12VAC30-50-75. Requirements relating to payment for covered outpatient drugs for the medically needy.
A. 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. 1. The Medicaid
agency provides coverage for the following excluded or otherwise restricted
drugs or classes of drugs, or their medical uses to all Medicaid recipients,
including full benefit dual eligible beneficiaries under the Medicare
Prescription Drug Benefit Part D. The following excluded drugs are covered:
a. 1. Agents when used for anorexia, weight loss,
weight gain (see specific drug categories in subsection B of this section);
b. 2. Agents when used for the symptomatic relief
cough and colds (see specific drug categories in subsection B of this section);
c. 3. Prescription vitamins and mineral products,
except prenatal vitamins and fluoride (see specific drug categories in
subsection B of this section);
d. 4. Nonprescription drugs (see specific drug
categories in subsection B of this section);
e. 5. Barbiturates, except for dual eligible
individuals when used in the treatment of epilepsy, cancer, or a chronic mental
health disorder (see specific drug categories in subsection B of this
section); and
f. 6. Benzodiazepines, except for dual
eligible individuals as Part D will provide coverage for all conditions
(see specific drug categories in subsection B of this section).
B. Coverage of specific categories of excluded drugs will be in accordance with existing Medicaid policy as described in 12VAC30-50-520.