471 Neb. Admin. Code, ch. 16, § 008

Current through June 17, 2024

Section 471-16-008 - NON-COVERED DRUGS

Payment by Nebraska Medicaid will not be approved for:

(A) Requests for Quantities not in compliance with the requirements of this chapter:

(B) Experimental drugs or drugs not approved by the Food and Drug Administration:

(C) Drugs or other items not prescribed for a medically accepted indication:

(D) Drugs or other items prescribed or recommended for weight control or appetite suppression:

(E) Any alcoholic beverage;

(F) Drug Efficacy Study Implementation Program drugs identified as Less Than Effective or identical. Related, or Similar with an indicator value assigned by the Food and Drug Administration of either 5 or 6;

(G) Personal care items;

(H) Medical supplies and certain drugs for nursing facility and intermediate care facility patients:

(I) Over-the-counter drugs not listed on the Nebraska Medicaid Pharmacy Program website:

(J) Drugs or other items used for cosmetic purposes or hair growth:

(K) Baby foods, milk substitutes, or metabolic agents normally supplied by the Department:

(L) Drugs distributed or manufactured by certain drug manufacturers or labelers which have not agreed to participate in the drug rebate program:

(M) Products used to promote fertility;

(N) Medications dispensed as partial month fills for nursing facility or group home residents when dispensed by more than one pharmacy;

(O) Medications dispensed to replace products which have been recalled by the drug manufacturer:

(P) Drugs, or other products of manufacturers or labelers identifiable as non-covered on the Nebraska Point of Purchase System or on the Nebraska Medicaid Pharmacy Program website:

(Q) Drugs, classes of drugs, or therapeutic categories of drugs which are Medicare Part D Drugs and Medicare Part D Covered supplies or equipment, for all individuals eligible for benefits under Medicare Part D, whether or not the individual is enrolled in a Medicare Part D Plan;

(R) Drugs or classes of drugs approved by the Federal Food and Drug Administration for treatment of sexual or erectile dysfunction, or drugs or classes of drugs which are being used for the treatment of sexual or erectile dysfunction. Drugs or classes of drugs which are approved by the Federal Food and Drug Administration for treatment of sexual or erectile dysfunction and for conditions other than treatment of sexual or erectile dysfunction, and are prescribed for those other conditions may be covered, but Nebraska Medicaid may require prior authorization: and

(S) Automatic refills.

471 Neb. Admin. Code, ch. 16, § 008

Adopted effective 12/26/2021