Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-073 - State Plan Amendment #2005-008

Current through Register Vol. 49, No. 6, June, 2024
ATTACHMENT 3.1-A
AMOUNT, DURATION AND SCOPE OF
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.