R414-60-3. Member Eligibility Requirements

(1) Medicaid covers prescription drugs for individuals who are categorically and medically needy under the Medicaid program. (2) In accordance with Subsection 1935(a) of the Social Security Act, Medicaid does not cover outpatient drugs included in the Medicare Prescription Drug Benefit-Part D for full-benefit dual eligible members. Certain limited drugs provided in accordance with Subsection 1927(d)(2) of the Social Security Act to Medicaid members, but not included in the Medicare Prescription Drug Benefit-Part D, are payable by Medicaid. (3) Outpatient drugs included in contracts with the Accountable Care Organization (ACO) must be obtained through the ACO for members enrolled in an ACO. (4) Classes of medications and individual drugs carved out from the ACO must be obtained through the fee-for-service benefit.