2703

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 B1, Vitamin B6, Vitamin B12, 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.

SOURCE: Final Rulemaking published at 59 DCR 2298, 2300 (March 23, 2012); as amended by Final Rulemaking published at 65 DCR 7837 (July 27, 2018).