What are the provisions for coverage of legend medications for Indiana Medicaid?
Indiana Medicaid covers drugs in accordance with the IHCP rule 405 IAC 5-24-3, which is as follows: 405 IAC 5-24-3 Coverage of legend drugs Authority: IC 12-8-6-5; IC 12-15-1-10; IC 12-15-21-2 Affected: IC 12-13-7-3; IC 12-15 Sec. 3. • A legend drug is covered by Indiana Medicaid if the drug is: • approved by the United States Food and Drug Administration; • not designated by the Health Care Financing Administration (HCFA) as less than effective, or identical, related, or similar to a less than effective drug; • subject to the terms of a rebate agreement between the drug’s manufacturer and the HCFA; and • not specifically excluded from coverage by Indiana Medicaid. • The following are not covered by Indiana Medicaid: • Anorectics or any agent used to promote weight loss. • Topical minoxidil preparations. • Fertility enhancement drugs. • Drugs when prescribed solely or primarily for cosmetic purposes.
