D.C. Mun. Regs. tit. 29, r. 29-2703

Current through Register Vol. 71, No. 49, December 6, 2024

Rule 29-2703 - REIMBURSEMENT FOR PRESCRIPTIONS

2703.1

The District of Columbia Medicaid Program shall reimburse claims submitted by participating providers for the following prescriptions:

(a) Legend drugs that are approved for safety and effectiveness as prescription drugs by the U.S. Food and Drug Administration ("FDA") and prescribed for their FDA-approved indication;

(b) Over-the-counter ("OTC") medications as listed in the District Medicaid Preferred Drug List and the Pharmacy Billing Manual. The following categories of OTC medications shall be covered when prescribed by a licensed provider:

(1) Oral Analgesics with a single active ingredient (e.g., aspirin, acetaminophen, and ibuprofen);

(2) Ferrous salts (sulfate, gluconate);

(3) Antacids (aluminum, magnesium, bismuth);

(4) Diabetic preparations (e.g., Insulin);

(5) Single agent Vitamin Bl, Vitamin B6, Vitamin Bl2, Vitamin D, folic acid products, and geriatric vitamins;

(6) Family planning drugs;

(7) Senna extract;

(8) Smoking cessation products;

(9) Single ingredient antihistamine medications;

(10) Single ingredient cough and cold medications; and

(11) Select agents when used for anorexia, weight loss, or weight gain as indicated in the District Medicaid Preferred Drug List and the Pharmacy Billing Manual;

(c) Prenatal vitamins and fluoride preparations, as required under Section 1927 of the Social Security Act;

(d) Diabetic preparations (e.g., blood glucose monitors, blood glucose test strips, syringes), when prescribed by a licensed provider; and

(e) Other drugs or products used for mitigating disease in the event of a public health emergency.

D.C. Mun. Regs. tit. 29, r. 29-2703

Notice of Final Rulemaking published at 59 DCR 2298, 2301 (March 23, 2012); amended by Final Rulemaking published at 65 DCR 7824 (7/27/2018)

Authority: The Director of the Department of Health Care Finance (DHCF), pursuant to the authority set forth in An Act to enable the District of Columbia to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program, and for other purposes, approved December 27, 1967 (81 Stat. 774; D.C. Official Code § 1-307.02 (2006 Repl. & 2011 Supp.)) and section 6(6) of the Department of Health Care Finance Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109; D.C. Official Code § 7-771.05(6) (2008 Repl.)).