Pharmacy Benefit Carve Out

*The below information was distributed by WV Bureau for Medical Services as guidance related to the pharmacy benefit carve out, effective July 1, 2017.*

Pharmacy Benefit Carve Out

1. Injectable drugs managed on the Preferred Drug List (PDL) will be covered as pharmacy (through WV State Fee-for-Service) benefits including, but not limited to, Vivitrol, Pulmonary Hypertension Agents, Hematopoietic Factors, Colony Stimulating Factors, Multiple Sclerosis Agents (limited to PDL), and Inhaled Cystic Fibrosis Agents, provided a prescription is written

2. Drugs to be administered at home are covered as pharmacy (through WV State Fee-for-Service) benefits.

3. Drugs to be administered in infusion centers or physician offices are to be covered as medical (through West Virginia Family Health MCO) benefits.
 
Notable exceptions (covered as pharmacy through WV State Fee-for-Service, assuming a prescription is provided):
1. Depo-Testosterone
2. Injectable Progestin Contraceptives (Depo-Provera, Medroxyprogesterone Acetate)
3. Lupron Depot
4. Makena
5. Synagis
6. Vaccines (those administered in a pharmacy)