Coverage of Part D Excluded Drugs - Kaiser State Health Facts

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Medicaid Coverage of Medicare Part D Excluded Drugs, 2009

Benzodiazapines

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	Benzodiazapines	Barbiturates	Weight Loss/Weight Gain/Anorexia Drugs	Cold and Cough Drugs	Vitamins and Minerals	Over-the-Counter Drugs	Restrictions on Coverage	Expected Co-payments

United States	48+DC Yes	47+DC Yes	13 Weight Loss, 12 Weight Gain, 9 Anorexia	30+DC Yes	35+DC Yes	46+DC Yes	15 Yes	NA

Alabama	Yes	Yes	Weight Loss	Yes	Yes	Yes	Weight loss only if co-morbidity is confirmed	$0.50 / $3
Alaska	Yes	Yes	No	No	Yes	Yes	No	$2
Arizona	Yes	Yes	Anorexia	No	No	Yes	No	$0
Arkansas	Yes	Yes	No	Yes	Yes	Yes	No	$0.50-$3
California	Yes	Yes	Anorexia	Yes	Yes	Yes	If the drug is non-formulary, then prior authorization is required	$0-$1
Colorado	Yes	Yes	No	Yes	Yes	Yes	Prior authorization is required for cold and cough; vitamins	$1.10 / $3.10
Connecticut	Yes	Yes	No	Yes	Yes	Yes	No	$0
Delaware	Yes	Yes	All	Yes	Yes	Yes	Weight loss and weight gain drugs must be proven medically necessary	$0
District of Columbia	Yes	Yes	No	Yes	Yes	Yes	No	$1
Florida	Yes	Yes	No	No	No	No	No	$0
Georgia	Yes	Yes	Weight Loss	Yes	Yes	Yes	Cold and cough medications are only for beneficiaries under age 21	$0.50-$3
Hawaii	Yes	Yes	No	Yes	No	Yes	No	$0
Idaho	Yes	Yes	No	No	Yes	Yes	No	$0
Illinois	Yes	Yes	No	No	No	Yes	No	$1.05 / $3.10
Indiana	Yes	Yes	Weight Gain	Yes	Yes	Yes	No	$3 ($0 in SNF/under age 18)
Iowa	Yes	Yes	Weight Loss	Yes	Yes	Yes	Must be on the formulary	$1 -$3
Kansas	No	No	No	No	No	No	No	NA
Kentucky	Yes	Yes	No	No	Yes	Yes	No	Varies
Louisiana	Yes	Yes	Weight Gain	No	Yes	No	No	$0.50-$3
Maine	Yes	Yes	No	Yes	Yes	Yes	No	$2.25 / 50% of cost of brand name drug with a cap of $10
Maryland	Yes	Yes	Weight Loss, Weight Gain	Yes	Yes	Yes	No	$1 / $3
Massachusetts	Yes	Yes	Anorexia, Weight Gain	No	Yes	Yes	No	$1-$3
Michigan	Yes	Yes	No	No	Yes	Yes	No	$1-$3
Minnesota	Yes	Yes	Weight Gain	Yes	Yes	Yes	No	$1 / $3
Mississippi	Yes	Yes	No	No	No	Yes	No	$3
Missouri	Yes	Yes	No	Yes	No	Yes	No	$0.50-$3
Montana	Yes	Yes	No	No	No	Yes	No	$1-$5 (5% of the drug cost, capped at $5)
Nebraska	Yes	Yes	No	Yes	Yes	Yes	Benzodiazapines must be generic	$2
Nevada	Yes	Yes	No	Yes	Yes	Yes	No	$1 / $3
New Hampshire	Yes	Yes	All	Yes	Yes	Yes	No	$1 / $2
New Jersey	Yes	Yes	All	Yes	Yes	Yes	No	$0
New Mexico	Yes	Yes	Weight Loss	Yes	Yes	Yes	Weight loss is only covered for certain medical conditions	$0
New York	Yes	Yes	Weight Gain	No	Yes	Yes	No	$0.50 for OTC; $1.10 / $3.20
North Carolina	Yes	Yes	No	Yes	Yes	Yes	No	$3
North Dakota	Yes	Yes	No	No	No	Yes	No	$1.10-$2.40 / $3.20-$6 ($0 in nursing home)
Ohio	Yes	Yes	No	Yes	Yes	Yes	Must get prior authorization for drugs not on the formulary	$0 / $2 ($3 if prior authorization required)
Oklahoma	Yes	Yes	No	No	No	Yes	No	$1-$2
Oregon	Yes	Yes	All	Yes	Yes	Yes	Prior authorization is required	$0-$3
Pennsylvania	Yes	Yes	No	No	No	Yes	No	$1-$3.10 / $3.10-$6
Rhode Island	Yes	Yes	Weight Loss	Yes	Yes	Yes	No	$0
South Carolina	Yes	Yes	No	No	Yes	Yes	No	$3
South Dakota	Yes	Yes	All	Yes	Yes	Yes	No	$3
Tennessee	No	No	No	No	No	No	No	NA
Texas	Yes	Yes	No	Yes	No	Yes	No	$1-$5
Utah	Yes	No	No	No	No	Yes	Limited circumstances for over-the-counter drugs	Varies
Vermont	Yes	Yes	Weight Loss, Weight Gain	Yes	Yes	Yes	Prior authorization is required for weight loss drugs	$1-$3
Virginia	Yes	Yes	Weight Loss	Yes	Yes	Yes	Prior authorization is required for weight loss and non-formulary drugs	Varies
Washington	Yes	Yes	Anorexia	Yes	Yes	Yes	No	$0
West Virginia	Yes	Yes	No	Yes	Yes	Yes	No	$0.50-$3
Wisconsin	Yes	Yes	No	No	No	Yes	A doctor's certification that the medication is necessary is required for over-the-counter drugs	$1.05 / $3.10
Wyoming	Yes	Yes	No	Yes	Yes	Yes	Only calcium and iron are covered under vitamins	$1- $3 (non-preferred brand)

(show/hide notes)

Notes:

Dash indicates that co-pays can range from the low number to the higher number.

Medicare is prohibited from covering certain classes of drugs. More information on the Medicare Prescription Drug Benefits is available from the Kaiser Family Foundation: http://www.kff.org/medicare/rxdrugbenefits/partddataspotlights.cfm.

Sources:

Medicare Rights Center, Special Data Request, 2009.

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