WAC 182-530-2100. Noncovered — Outpatient drugs and pharmaceutical supplies

(1) The medicaid agency does not cover: (a) A drug that is: (i) Not approved by the Food and Drug Administration (FDA); or (ii) Prescribed for a nonmedically accepted indication, including diagnosis, dose, or dosage schedule that is not evidenced-based. (b) A drug prescribed: (i) For weight loss or gain; (ii) For infertility, frigidity, impotency; (iii) For sexual or erectile dysfunction; (iv) For cosmetic purposes or hair growth; or (v) For treatment of cough or cold symptoms, except as listed in WAC 182-530-2000 (1)(h). (c) Drugs used to treat sexual or erectile dysfunction, in accordance with section 1927 (d)(2)(K) of the Social Security Act, unless such drugs are used to treat a condition other than sexual or erectile dysfunction, and these uses have been approved by the Food and Drug Administration. (d) Drugs listed in the federal register as "less-than-effective" ("DESI" drugs) or which are identical, similar, or related to such drugs. (e) Outpatient drugs for which the manufacturer requires as a condition of sale that associated tests or monitoring services be purchased exclusively from the manufacturer or manufacturer's designee. (f) A product: (i) With an obsolete National Drug Code (NDC) for more than two years; (ii) With a terminated NDC; (iii) Whose shelf life has expired; or (iv) Which does not have an eleven-digit NDC. (g) Over-the-counter (OTC) drugs, vitamins, and minerals, except as allowed under WAC 182-530-2000 (1)(h). (h) Any drug regularly supplied by other public agencies as an integral part of program activity (e.g., immunization vaccines for children). (i) Free pharmaceutical samples. (2) A noncovered drug can be requested through the exception to rule process as described in WAC 182-501-0160 . (3) For clients age 20 and younger, providers must follow the rules for the early periodic screening, diagnosis, and treatment program; see chapter 182-534 WAC.