- (1) Medicaid covers prescription drugs for individuals who are categorically and medically needy under the Medicaid program.
- (2) In accordance with Subsection 1935(a) of the Social Security Act, Medicaid does not cover outpatient drugs included in the Medicare Prescription Drug Benefit-Part D for full-benefit dual eligible members. Certain limited drugs provided in accordance with Subsection 1927(d)(2) of the Social Security Act to Medicaid members, but not included in the Medicare Prescription Drug Benefit-Part D, are payable by Medicaid.
- (3) Outpatient drugs included in contracts with the Accountable Care Organization (ACO) must be obtained through the ACO for members enrolled in an ACO.
- (4) Classes of medications and individual drugs carved out from the ACO must be obtained through the fee-for-service benefit.
KEY: Medicaid
Date of Last Change: January 20, 2026
Notice of Continuation: March 11, 2022
Authorizing, and Implemented or Interpreted Law: 26B-1-213; 26B-3-108