PURPOSE: This rule establishes a listing of non-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) 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.
2. (2) List of drugs or categories of drugs which are restricted to require prior authorization for certain specified indications—

Drug or Category of Drug Abortifacients

Butorphanol, nasal spray

Drugs used to treat sexual dysfunction

Histamine 2 Receptor Medically accepted uses Antagonists

Ketorolac, oral

Linezolid, oral

Modafanil

Proton Pump Inhibitors

AUTHORITY: sections 208.152, 208.153 and 208.201, RSMo 1994.* Emergency rule filed Nov. 21, 2000, effective Dec. 1, 2000, expired May 29, 2001. Original rule filed June 29, 2000, effective Feb. 28, 2001.

*Original authority: 208.152, RSMo 1967, amended 1969, 1971, 1972, 1973, 1975, 1977, 1978, 1978, 1981, 1986, 1988, 1990, 1992, 1993; 208.153, RSMo 1967, amended 1973, 1989, 1990, 1991; and 208.201, RSMo 1987. Allowed Indications Termination of pregnancy resulting from an act of rape or incest or when necessary to protect the life of the mother Override of quantity restriction allowed for medically accepted uses Sexual dysfunction Short-term treatment of moderately severe acute pain following injection of same entity Medically accepted uses Narcolepsy Medically accepted uses 13 CSR 70-20