Prescription Drugs Permitted by State Law, Certain Sample Clauses

Prescription Drugs Permitted by State Law, Certain. Medical Supplies and Enteral Formula Not Covered by Medicare NYS Medicaid continues to provide coverage for categories of drugs excluded from the Medicare Part D benefit such as barbiturates, benzodiazepines, and some prescription vitamins, and some non-prescription drugs. NYS also provides a wrap around program which covers medications that are included in the Part D benefit when the recipient is unable to receive them from his or her Part D plan. Effective January 1, 2007, drugs which are covered through this Medicaid wrap-around benefit will be limited to the following four categories of drugs: 1) atypical antipsychotics, 2) antidepressants, 3) antiretrovirals used in the treatment of HIV/AIDS, and 4) anti-rejection drugs used in the treatment of tissue and organ transplants, but only when 1) these drugs are not covered by the specific plan, 2) the patient does not meet the plan's utilization management requirements, or 3) there are quantity limits inconsistent with the prescribed amount. Certain medical/surgical supplies and enteral formula covered by Medicaid and not included in the Contractor's Medicare Advantage Benefit Package also will be paid for by Medicaid fee-for-service. Medical/surgical supplies are items other than drugs, prosthetic or orthotic appliances, or DME, which have been ordered by a qualified practitioner in the treatment of a specific medical condition and which are: consumable, non-reusable, disposable, or for a specific rather than incidental purpose, and generally have no salvageable value (e.g. gauze pads, bandages and diapers). Pharmaceuticals and medical supplies routinely furnished or administered as part of a clinic or office visit are covered by the Contractor.