In addition to the items and services not specifically listed in § 67:16:14:04, the following items and services are not covered under this chapter:

1. (1) Nonlegend prescription drugs and over-the-counter items and medical supplies except for those items covered under § 67:16:14:04;
2. (2) Medical supplies or delivery charges;
3. (3) Legend oral vitamins except for legend vitamins prescribed for the prenatal care of pregnant women covered under § 67:16:14:04;
4. (4) Nicotine patches and other nicotine replacement products;
5. (5) Agents to promote fertility or treat impotence;
6. (6) Agents used for cosmetic purposes;
7. (7) Hair growth products;
8. (8) Items or drugs manufactured by a firm that has not signed a rebate agreement with the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services;
9. (9) Items that exceed a 34-day supply, except for 90-day fills on select generic maintenance medications, family planning items, and prenatal vitamins;
10. (10) Services, procedures, or drugs considered experimental, not including services, procedures, or drugs approved by the Food and Drug Administration under an emergency use authorization that are being utilized in accordance with the emergency use authorization;
11. (11) Drugs and biologicals that the federal government has determined to be less than effective according to Pub. L. No. 97-35, § 2103 (August 13, 1981), 95 Stat. 787; and

12. (12) Drugs that did not receive prior authorization from the department under this chapter.

    Notes: Information about drugs that have been determined to be less than effective is available at https://data.medicaid.gov/Drug-Pricing-and-Payment/Drug-Products-in-the-Medicaid-Drug-Rebate-Program/v48d-4e3e/data.

    A list of drugs that require prior approval is available at https://prdgov-rxadmin.optum.com/rxadmin/SDM/Prior_authorization.html.

Source: SL 1975, ch 16, § 1; 1 SDR 77, effective May 29, 1975; 4 SDR 10, effective August 28, 1977; 4 SDR 35, effective December 22, 1977; 7 SDR 23, effective September 18, 1980; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 13 SDR 8, effective August 3, 1986; 14 SDR 46, effective September 28, 1987; 15 SDR 2, effective July 17, 1988; 16 SDR 234, effective July 1, 1990; 17 SDR 200, effective July 1, 1991; 22 SDR 32, effective September 11, 1995; 22 SDR 93, effective January 7, 1996; 28 SDR 166, effective June 12, 2002; 31 SDR 214, effective July 6, 2005; 32 SDR 129, effective February 1, 2006 ; 47 SDR129, effective June 3, 2021; 48 SDR 39, effective October 3, 2021 .

General Authority: SDCL 28-6-1 (1)(2) .

Law Implemented: SDCL 28-6-1 .

Prior versions effective: 2021-06-03, 2006-02-01.