BMS Pharmacy Main


	BMS Pharmacy Services
		The outpatient pharmacy program is an optional service provided by the Bureau for Medical Services to Medicaid recipients. It is the most utilized service of the Bureau with approximately one half of all clients receiving services monthly.
		State Maximum Allowable Costs (SMAC) List WV Medicaid Limitations - Updated 05/13/2009

Drug Utilization Review Board click here
top of page			The DUR Board was mandated by OBRA '90 legislation and meets quarterly to discuss issues pertaining to the rational use of drugs. It is advisory in nature offering input into cost effectiveness of the drug program.
Preferred Drug List click here
top of page			The Preferred Drug List is a medication list recommended to the Bureau for Medical Services by the Medicaid Pharmaceutical and Therapeutics (P & T) Committee and approved by the Secretary of the Department of Health and Human Resources, as authorized by West Virginia Code 9-5-15. The drugs which are indicated as "preferred" have been selected for their clinical significance and overall efficiencies. All Medicaid-covered drugs noted as "non-preferred" will continue to be available through the prior authorization process. Some select preferred drugs may require prior authorization, as noted. A three-day emergency supply of prior-authorized drugs can be dispensed by a pharmacy until authorization is completed. Please note: The PDL only addresses certain drug classes. Some classes of drugs will not be reviewed for preferential agents because of no or limited cost savings. Therefore, drugs which have historically been covered by Medicaid and are not listed on the Preferred Dug List will continue to be covered. New drugs introduced into the marketplace in therapeutic classes that have been reviewed will be considered non-preferred until the annual review of the particular therapeutic class. Exceptions to this policy will be made for drugs which the FDA has given priority status.


Rational Drug Therapy Program (RDTP) click here
top of page			The Rational Drug Therapy Program (RDTP) was implemented through the West Virginia University School of Pharmacy to provide prior authorization drug services to the West Virginia Medicaid Program. RDTP provides clinical research of drug use guidelines, which are then reviewed by the Drug Utilization Review Board.

Generic Antihistamine NDCs click here
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Covered Over the Counter Drugs - (OTC Drugs)
			West Virginia Medicaid covers selected over-the-counter (OTC) drugs pursuant to a legal prescription in writing or verbal order of a licensed prescriber. Covered products must be manufactured by pharmaceutical companies who are participating in the Federal Drug Rebate Program. Only generic products are covered, unless otherwise specified. OTC drugs are not covered for residents of long-term care facilities. Charges to Medicaid shall be no more than what is charged to the general public for retail sale
top of page			OTC drugs are covered with a prescription as follows: (residents in skilled and intermediate nursing facilities are excluded for coverage of the OTC agents).
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			1. Family Planning Supplies. 2. Plain Niacin tablets 3. Multiple Vitamins for children to age 21. 4. Prenatal Vitamins for women through age 45. 5. Plain ferrous sulfate, gluconate , fumerate. 6. Calciferol Drops 7. Diabetic supplies, syringes, and testing agents. 8. Asprin and buffered asprin in quantities of 1000 tablets. 9. End Stage Renal Disease (ESRD) vitamins, vitamin/mineral preparations, and other OTC agents related to ESRD.
			Analgesics (Topical) Capsaicin Antacids Alginic Acid Combinations Aluminum Hydroxide Oral Liquid Magnesium Hydroxide Oral Liquid and Tablets Aluminum HCl/Magnesium HCl Combination Liquid Calcium Carbonate Oral Tablets Antibacterial Agents (Topical) Triple Antibiotic Cream Triple Antibiotic Ointment Anti-Inflammatory Agents (Topical) Hydrocortisone 0.5% Cream and Ointment Hydrocortisone 1% Cream and Ointment Antifungals (Vaginal and Topical) Miconazole Nitrate Vaginal Cream/Suppositories Miconazole Topical Cream Clotrimazole Vaginal Cream/suppositories Clotrimazole Topical Cream Tolnaftate Topical Cream Antihistamines Diphenhydramine 25 mg. Capsules and Tablets Diphenhydramine 12.5 mg/5ml Elixir Chlorpheniramine Oral Liquid Chlorpheniramine Oral Tablets 4 mg. Antihistamines/Decongestant Combinations Triaminic Syrup (generic) Triaminic Expectorant (generic) Triaminic DM (generic) Anti-Parasitics (Brands Allowed) Pyrethins/Piperonyl butoxide (A-200) Rid (Gel, Liquid, Shampoo) Permethrin 1% Liquid (Nix) Antipyretics/Analgesics Acetaminophen Liquid and Infant Drops Acetaminophen Tablets and Caplets (80-650 mg.) Acetaminophen Rectal Suppositories 120-650 mg.) Aspirin Tablets (81 mg.-650 mg.) Ibuprofen 200 mg. Tablets Ibuprofen Oral Suspension (Children’s Motrin and Advil allowed) Calcium Preparations Calciferol Drops Calcium Carbonate Tablets Cough Syrups Guaifenesin Syrup Guiafenesin Syrup (Sugar Free) Guaifenesin/Dextromethorphan Syrup {limited to 4 ounce quantity} Guaifenesin/Dextromethorphan Syrup (Sugar Free) {limited to 4 ounce quantity} Laxatives Milk of Magnesia Nasal Decongestants Pseudoephedrine Syrup Pseudoephedrine 30 and 60 mg. Tablets




Covered Cough and Cold Medications click here
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Unisys Pharmacy Information click here
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AIDS Drug Assistance Program Fact Sheet click here
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Office of Pharmacy Services / 350 Capitol Street Room 251 / Charleston, WV 25301-3709