covered outpatient drug

(3)The term “covered outpatient drug” does not include any drug, biological product, or insulin provided as part of, or as incident to and in the same setting as, any of the following (and for which payment may be made under this subchapter as part of payment for the following and not as direct reimbursement for the drug): (A)Inpatient hospital services. (B)Hospice services. (C)Dental services, except that drugs for which the State plan authorizes direct reimbursement to the dispensing dentist are covered outpatient drugs. (D)Physicians’ services. (E)Outpatient hospital services. (F)Nursing facility services and services provided by an intermediate care facility for the mentally retarded. (G)Other laboratory and x-ray services. (H)Renal dialysis.

Source

42 USC § 1396r-8(k)(3)


Scoping language

In this section
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