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Delaware General AssemblyDelaware RegulationsMonthly Register of RegulationsAugust 2016

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Regulatory Flexibility Act Form

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1927(d)(2) of the Social Security Act, Limitations on coverage of drugs, drugs subject to exclusion
1935(d)(2) of the Social Security Act, Coverage of certain excludable drugs
Center for Medicaid and CHIP Services (CMCS) Informational Bulletin 060116, Medicaid Benefits Available for the Prevention, Detection and Response to the Zika Virus
Del.C., Title 29, Ch. 101, §10119, Administrative Procedures, Emergency Regulations
In accordance with the federal public notice requirements established at Section 1902(a)(13)(A) of the Social Security Act and 42 CFR 447.205 and the state public notice requirements of Title 29, Chapter 101 of the Delaware Code, Delaware Health and Social Services (DHSS)/Division of Medicaid and Medical Assistance (DMMA) gives public notice and provides an open comment period for thirty (30) days to allow all stakeholders an opportunity to provide input to the coverage of outpatient drugs for the categorically needy. Comments must be received by 4:30 p.m. on August 31, 2016.
Pursuant to 1927(d)(2) and 1935(d)(2) of the Social Security Act, the Medicaid Agency provides coverage for the following excluded or otherwise restricted drugs or classes of drugs, or their medical uses to all Medicaid recipients, including full benefit dual eligible beneficiaries under the Medicare Prescription Drug Benefit - Part D.
The following excluded drugs are covered:
(a) 1.) Agents when used for anorexia, weight loss, and weight gain. Products in these categories require prior
authorization; see specific drug categories below:
a.) Megestrol Acetate,
b.) Somatropin, and
c.) Lipase Inhibitor
(b) Agents when used to promote fertility; see specific drug categories below:
(c) Agents when used for cosmetic purposes or hair growth; see specific drug categories below:
(d) Agents when used for the symptomatic relief cough and colds; see specific drug categories below:
(e) Prescription vitamins and mineral products, except prenatal vitamins and fluoride; see specific drug categories
(f) Nonprescription drugs; see specific drug categories below.
2.) Nonprescription drugs, prescription vitamins and mineral products (except prenatal vitamins and fluoride), and other over-the-counter products, such as agents used for the symptomatic relief of cough and colds, as listed in the Delaware Medicaid and Medical Assistance (DMMA) Pharmacy Provider Manual Appendix A - Covered Over-the-Counter Drugs.
Citation (s) Provision (s)
1927(d)(2) and 1935(d)(2) (g) covered outpatient drugs which the manufacturer
Last Updated: December 31 1969 19:00:00.
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