You asked what prescription drugs are covered under Connecticut's Medicaid program, and in particular about birth control prescriptions and Viagra.

SUMMARY

Connecticut's Medicaid program covers medically approved drugs, supplies, and devices "which are prescribed or furnished to persons of childbearing age for the purpose of enabling such individuals to freely determine the number and spacing of their children." (Title XIX of the Social Security Act (Medicaid) requires that states cover such family planning services.) And while the Title XIX does not require states to cover other prescription drugs, when they do so they must follow federal law.

The Omnibus Budget Reconciliation Act of 1990 (OBRA '90) requires, with a few exceptions, states that voluntarily cover outpatient drugs to cover, for their medically accepted indications, all FDA-approved prescription drugs of manufacturers that have entered into drug rebate agreements with the Health Care Financing Administration. More than 500 drug companies (including Pfizer, the manufacturer of Viagra, which the FDA approved as a treatment for male erectile dysfunction last March) have done so. The Department of Social Services (DSS) reports that it has covered Viagra prescriptions since April 1998.

As permitted under OBRA '90, Connecticut's state Medicaid plan does not cover several drugs or classes of drugs. They are: (1) over the counter (OTC) drugs or nutritional supplements for nursing home patients; (2) vaccines that the Department of Public Health provides without charge; (3) drugs used in the treatment of obesity; (4) drugs the FDA has identified as lacking sufficient evidence of effectiveness; (5) controlled substances dispensed to Medicaid recipients in amounts which exceed the product manufacturer's recommendation for safe and effective use, if the pharmacy cannot document a medical justification for doing so; (6) alcoholic liquors; (7) OTCs that are not listed on the state's "formulary" (preferred drug list); (8) anything of an unproven, experimental, or research nature; (9) items used for personal care and hygiene or for cosmetic purposes; (10) drugs solely used to promote fertility; and (11) drugs used to promote smoking cessation.

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