10.09.03.04

.04 Covered Services.

A. The Department shall cover:

(1) Legend drugs except certain drugs for which federal financial participation is prohibited pursuant to 42 CFR §441.25;

(2) Schedule V cough preparations;

(3) Contraceptives;

(4) Hypodermic needles and syringes;

(5) Enteral nutritional and supplemental vitamins and mineral products given by nasogastric, jejunostomy, or gastrostomy tube in the home;

(6) Enteric coated aspirin when prescribed for:

(a) The treatment of arthritic conditions as certified on the prescription in the prescriber's own handwriting or by the dispenser after consultation with the prescriber; and

(b) At least 250 tablets of 325 milligrams each, whether for initial prescriptions or refills.

(7) Nonlegend ferrous sulfate oral preparations in the following strengths, dosage forms, and quantities only:

(a) Drops (125 milligrams per milliliter) in units of 50 milliliter dropper bottles;

(b) Elixir (220 milligrams per 5 milliliters) in quantities of at least 473 milliliters;

(c) Syrup (90 milligrams per 5 milliliters) in quantities of at least 473 milliliters; and

(d) Tablets (300 milligrams to 325 milligrams) in quantities of at least 100 tablets;

(8) Nonlegend chewable tablets of any ferrous salt if:

(a) The tables are combined with vitamin C, multivitamins, multivitamins and minerals, or other minerals;

(b) The participant is under 12 years old; and

(c) The quantity dispensed is at least 60 tablets and not more than a 100-day supply;

(9) Nonlegend ergocalciferol liquid (8,000 international units per milliliter); and

(10) Any nonlegend drug determined by the Program to be cost effective.

B. Prescription Requirement.

(1) Except as provided in §B(2) of this regulation, a prescription is required for all items to be covered under this regulation even if the item is not a legend drug or otherwise does not require a prescription under federal or State pharmacy law.

(2) A prescription is not required for various forms of latex condoms or other drugs or products identified by the Program, each within the limits established by the Program,