5101:3-9-12 Office of medical assistance list of drugs covered without prior authorization.

(A) The drug products covered under the medicaid program without prior authorization are specified in appendix A to this rule. The table includes four columns to indicate drug coverage.

(1) Drug class. This column describes the therapeutic class of drug.

(2) Drug name. This column names each drug covered under the medicaid program without prior authorization.

(3) Co-payment. This column indicates the medicaid co-payment that applies to each drug in accordance with rule 5101:3-9-09 of the Administrative Code. "2" indicates that a two dollar co-payment applies, "0" indicates that zero co-payment applies, and "*" indicates that the drug is only available without prior authorization for children who are exempt from co-payment requirements under rule 5101:3-9-09 of the Administrative Code. If the drug is prior authorized for an adult, the appropriate co-payment for prior authorized drugs will apply.

(4) Covered for dual eligible. This column indicates whether the drug is covered under the medicaid program for a consumer who is a dual eligible as defined in rule 5101:3-1-05 of the Administrative Code. "Y" indicates that the drug is covered for a dual eligible and "N" indicates that the drug is not covered for a dual eligible.

(B) Revisions to appendix A to this rule shall be filed pursuant to Chapter 119. of the Revised Code unless the revisions are required to comply with rule 5101:3-9-03 of the Administrative Code, state statute, and/or federal statute or regulations relating to federal financial participation in the medicaid program.

(C) Drugs not listed in appendix A to this rule that are classified in the following drug classes will not require prior authorization if the pharmacy claim indicates that the prescriber is a physician who has registered his or her psychiatry specialty with the office of medical assistance, and when the dosage form of the drug prescribed is a standard tablet or capsule:

(1) Selective serotonin reuptake inhibitor (SSRI);

(2) Alpha-2 receptor antagonist;

(3) Selective serotonin-norepinephrine reuptake inhibitor (SNRI);

(4) Selective norepinephrine and dopamine reuptake inhibitor (NDRI);

(5) Monoamine oxidase inhibitor, non-selective and irreversible;

(6) Antipsychotic, atypical, dopamine and serotonin antagonist;

(7) Antipsychotic, atypical, D2 partial agonist/5HT mixed; or

(8) SSRI and antipsychotic, dopamine and serotonin antagonist combination.

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Effective: 01/01/2013
R.C. 119.032 review dates: 10/01/2015
Promulgated Under: 119.03
Statutory Authority: 5111.0112 , 5111.02 , 5111.98
Rule Amplifies: 5111.01 , 5111.0112 , 5111.02 , 5111.021 , 5111.081 , 5111.084 , 5111.98
Prior Effective Dates: 11/1/85 (Emer), 1/31/86, 5/1/86, 8/1/86, 11/1/86, 2/2/87 (Emer), 5/1/87, 8/1/87, 10/29/87 (Emer), 1/20/88 (Emer), 4/18/88, 8/6/88, 11/1/88, 1/19/89, 1/20/89 (Emer), 4/20/89, 6/9/89 (Emer), 8/3/89, 11/1/89, 2/1/90, 5/1/90, 8/1/90 (Emer), 11/1/90, 12/31/90 (Emer), 3/31/91, 8/22/91, 2/10/92, 7/11/92, 10/25/92, 4/1/93, 6/18/93, 11/11/93, 3/18/94, 8/25/94, 3/20/95, 5/25/95, 9/1/95, 2/1/96, 9/13/96, 3/22/97, 8/14/97, 1/23/98, 7/1/98, 1/1/99, 3/31/99, 7/1/99, 4/1/00, 11/12/00, 3/19/01, 8/30/01, 12/13/01, 3/21/02, 8/15/02, 11/22/02, 3/31/03 (Emer), 6/12/03, 9/30/03, 4/1/04, 10/1/04, 4/14/05, 10/1/05, 1/1/06, 7/1/06, 10/1/06, 7/10/07, 10/1/07, 3/20/08, 10/1/08, 7/1/09, 10/1/09, 10/1/10, 7/1/11, 10/1/11, 7/19/12, 10/1/12