Utah Admin. Code R414-60-3 - Member Eligibility Requirements
(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.
Notes
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