PURPOSE: This rule establishes a listing of excludable drugs and categories of drugs for which prior authorization is required in order for them to be reimbursable under the Missouri Medicaid Pharmacy Program.

1. (1) Permissible Exclusions—As specified in the Social Security Act, 1927(d)(1)(B), states may exclude or otherwise restrict coverage of certain covered outpatient drugs. Section 1927(d)(2) of the Social Security Act provides a listing of the categories of drugs that are permissible for exclusion. Drugs included on this list may be excluded from coverage entirely or restricted by diagnosis as determined by the state.
2. (2) As specified in Section 1927(d)(1) of the Social Security Act, states may subject to prior authorization any covered outpatient drug. Any such prior authorization program shall comply with the requirements of Section 1927(d)(5) of the Social Security Act.
3. (3) List of drugs or categories of drugs which are restricted to require prior authorization for certain specified indications—

Drug or Category of Drug Amphetamines

Barbiturates (with the exception of phenobarbital and mephobarbital and methabarbital which do not require prior authorization)

Isotretinoin Ketoralac, oral

Retinoic Acid, topical Sildenafil Citrate

AUTHORITY: sections 208.153 and 208.201, RSMo 1994.* Original rule filed Dec. 13, Section Allowed Indications Attention Deficit Hyperactivity Disorder Narcolepsy All medically accepted uses Noncosmetic uses Short-term treatment of moderately severe acute pain following injection of same entity Noncosmetic uses Erectile dysfunction 1991, effective Aug. 6, 1992. Amended: Filed May 15, 1992, effective Jan. 15, 1993. Amended: Filed March 1, 1996, effective Oct. 30, 1996. Amended: Filed May 27, 1999, effective Dec. 30, 1999.

*Original authority: 208.153, RSMo 1967, amended 1973, 1989, 1990, 1991 and 208.201, RSMo 1987.