| Program Name: | BadgerCare Plus and Medicaid | Handbook Area: | Pharmacy | | 07/03/2025 | Covered and Noncovered Services : Covered Services and RequirementsTopic #1934 Legend Drugs
Most legend drugs and many OTC drugs are covered.
As defined under Wis. Admin. Code § DHS 101.03(94), a legend drug is any drug that requires a prescription under federal code 21 USC 353(b). Legend drugs are covered when:
- The drug is approved by the FDA and is not on the Wisconsin Medicaid Negative Formulary List.
- The manufacturer has signed a federal rebate agreement for the drug.
- The manufacturer has reported the drug information to First DataBank.
Some covered drugs may require PA; others require an appropriate diagnosis code or have other restrictions for reimbursement. |