S.D. Admin. R. 67:16:14:04

Current through Register Vol. 51, page 57, November 12, 2024

Section 67:16:14:04 - Items and services covered

A prescription is required for all of the items and services and nonlegend drugs and supplies covered under this section. The following prescription drugs, biologicals, and related items and services are covered under this chapter:

(1) Legend eye preparations, vaginal therapeutics, otic pharmaceutical preparations, or inhalations for asthmatic conditions;

(2) Antibiotic products which are known, either by sensitivity test or product information, to be the single item of choice for the diagnosis;

(3) All other legend prescription drugs and biologicals, except for the items listed in § 67:16:14:05;

(4) Insulin;

(5) Concentrated cryoprecipitate used in the home treatment of hemophilia;

(6) Legend vitamins prescribed for the prenatal care of pregnant women;

(7) Calcitriol if used for renal impairment and determined medically necessary by the prescriber;

(8) Spacers, such as Aerochamber and InspirEase, and solutions that are medically necessary for the administration of legend drugs used for the delivery of respiratory or inhalation therapy;

(9) Syringes and needles for the administration of medication covered under this chapter;

(10) Urine and blood testing items for a diabetic, except for glucometers which are covered under the provisions of chapter 67:16:29; and

(11) The OTC items recommended for coverage by the P and T committee and approved for coverage by the department.

S.D. Admin. R. 67:16:14:04

SL 1975, ch 16, § 1; 1 SDR 77, effective 5/29/1975; 4 SDR 10, effective 8/28/1977; 7 SDR 23, effective 9/18/1980; 7 SDR 66, 7 SDR 89, effective 7/1/1981; 12 SDR 70, effective 10/31/1985; 13 SDR 8, effective 8/3/1986; 15 SDR 2, effective 7/17/1988; 16 SDR 234, effective 7/1/1990; 22 SDR 32, effective 9/11/1995; 31 SDR 21, effective 8/25/2004.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.

Covered services must be medically necessary, § 67:16:01:06.02.