Pharmacy Services

PHARMACY SERVICES

The Division of Medicaid and Health Financing (DMHF) will submit changes to the Medicaid State Plan in order to implement coverage changes for barbiturate and benzodiazepine drugs. These changes are necessary to comply with Medicaid program requirements relating to the coverage of drugs in the Medicaid program that are also covered in the Medicare Part D program for dual eligible individuals.

SPA 13-001-UT Pharmacy Services, therefore, amends the coverage of barbiturates and benzodiazepine drugs in Attachments 3.1-A and 3.1-B of the State Plan to clarify drug coverage for these drug classes. All barbiturates are covered under Medicaid, except for butalbital containing products and except for dual eligible individuals effective January 1, 2013, when these drugs are used in the treatment of epilepsy, cancer, or a chronic mental health disorder since Medicare Part D will cover those indications. Benzodiazepines are covered under Medicaid except for dual eligible individuals effective January 1, 2013, since Medicare Part D will cover all indications for the benzodiazepines.

DMHF anticipates a decrease in overall total annual expenditures by approximately $300,000 to result from these changes. This is due to a shift in coverage for these drugs from Medicaid to Medicare for dual eligible individuals. This decrease will be offset by a slight increase in federal estimated quarterly rebate offset amount (EQROA); however, the specific impact is unknown.

These proposed changes, if approved, become effective on January 1, 2013.

These proposed changes are pending Centers for Medicare & Medicaid Services approval. A copy of the changes may be obtained from Craig Devashrayee (801-538-6641), or by writing the Technical Writing Unit, Utah Department of Health, PO Box 143102, Salt Lake City, UT 84114-3102. Comments are welcome at the same address. Copies of the changes are also available at local county health department offices.

---