Prescribed Drugs Provider Manual - Iowa Department of Human ...

IowaDepartmentof HumanServicesProvider and ChapterPrescribed DrugsChapter III. Provider-Specific PoliciesPage13DateAugust 1, 20133. Drugs for Medicare EligiblesPrescription drugs for Medicaid members who also qualify for Medicare(referred to as “dual eligibles”) are paid through Medicare Part D effectiveJanuary 1, 2006. Medicaid does not cover any drugs covered under MedicarePart D for these members.Iowa Medicaid covers drugs in the following categories for dual eligiblemembers:♦ Barbiturates (except when used in the treatment of epilepsy, cancer, orchronic mental health disorder diagnoses)♦ Over-the-counter drugs (list posted at www.iowamedicaidpdl.com)♦ Prescription vitamin and minerals, except prenatal vitamins and fluoridepreparationsIowa Medicaid will accept only secondary claims for these drugs. Medicaidshould be listed as the secondary insurance for all dual eligibles. All claimsshould be submitted first to the primary insurance (Medicare Part D PDP).Iowa Medicaid will not pay for any Medicare Part B drugs, such as:♦ Oral immunosuppressant drugs,♦ Inhalation drugs when used with a nebulizer,♦ Oral chemotherapy drugs,♦ Oral anti-emetic drugs,♦ Blood clotting factors, or♦ Epoetin.A drug for which coverage is available to a dual eligible under Medicare Part Aor Part B must be billed to Medicare Part A or Part B.4. Preferred or Recommended DrugsDrug products designated on the Preferred Drug List as “P” (preferred) or “R”(recommended) do not require prior authorization unless the drug has anumber in the comments column to indicate a prior authorization is required,as defined on the first page of the Preferred Drug List. Seewww.iowamedicaidpdl.com for the current designations.