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Welcome  » May 28, 2023 9:05 AM
Program Name: BadgerCare Plus and Medicaid Handbook Area: Pharmacy

Covered and Noncovered Services : Covered Services and Requirements

Topic #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.

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