Section 405 IAC 5-24-3 - Coverage of legend drugsAuthority: IC 12-15-1-10; IC 12-15-21-2
Affected: IC 12-13-7-3; IC 12-15
Sec. 3.
(a) A legend drug is covered by Medicaid if the drug is: (1) approved by the United States Food and Drug Administration;(2) not designated by the Centers for Medicare and medicaid Services (CMS) as less than effective, or identical, related, or similar to a less than effective drug;(3) subject to the terms of a rebate agreement between the drug's manufacturer and CMS; and(4) not specifically excluded from coverage by Medicaid.(b) The following are not covered by Medicaid: (1) Anorectics or any agent used to promote weight loss.(2) Topical minoxidil preparations.(3) Fertility enhancement drugs.(4) Drugs when prescribed solely or primarily for cosmetic purposes.Office of the Secretary of Family and Social Services; 405 IAC 5-24-3; filed Jul 25, 1997, 4:00 p. m.: 20 IR 3345; filed Sep 27, 1999, 8:55 a.m.: 23 IR 319; readopted filed Jun 27, 2001, 9:40 a.m.: 24 IR 3822; readopted filed Sep 19, 2007, 12:16 p.m.: 20071010-IR-405070311RFA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFAFiled 8/1/2016, 3:44 p.m.: 20160831-IR-405150418FRAErrata filed 11/1/2016, 9:36 a.m.: 20161109-IR-405160493ACAReadopted filed 7/28/2022, 2:21 p.m.: 20220824-IR-405220205RFAReadopted filed 5/30/2023, 11:54 a.m.: 20230628-IR-405230292RFA