Fee-for-service Medicaid excluded drugs

Listed below are commonly excluded drugs and drug categories for fee-for-service Medicaid. This list is not all-inclusive, but lists frequently requested drugs.

Verify coverage of specific drugs using the NDC search site.

Drugs excluded for fee-for-service Medicaid

Drug or drug category	Example(s)	Comments
Erectile and sexual dysfunction treatments	Addyi; Cialis; Levitra; Osphena; Viagra	Treatment for erectile dysfunction and female sexual dysfunction is excluded from coverage per federal law
Drugs for cosmetic use or hair growth	Latisse; Botox Cosmetic; Rogaine	Drugs for cosmetic use or to treat hair loss are excluded from coverage per Title XIX of the Social Security Act
Drugs for weight loss	Phentermine; Belviq; Contrave; Qsymia	Drugs for weight loss are excluded from coverage per Minnesota Statutes 256B.0625, subd.13.
Drugs to treat infertility	Clomiphene	Drugs for treatment of infertility are excluded from coverage per Minnesota Statutes 256B.0625, subd.13.
DESI (Drug Efficacy Study Implementation) drugs	Midrin; Anusol HC suppositories	Drug products with a DESI 5 (less than effective) or DESI 6 (removed from market) designation are not considered a covered outpatient drug per Title XIX.
Benzonatate	Benzonatate; Tessalon; Zonatuss	Limited cough and cold preparations are covered by fee-for-service Medicaid. Covered products include: Guaifenesin and dextromethorphan Guaifenesin tablets Guaifenesin and codeine Guaifenesin syrup Guaifenesin and hydrocodone syrup
Fexofenadine	Allegra; Allegra-D; fexofenadine; fexofenadine with pseudoephedrine	Fexofenadine is excluded from coverage. Preferred alternatives include loratadine and cetirizine.
Investigational drugs	I-MIBG: stirapentol	Not covered per Minnesota state law.
Medical cannabis	Medical marijuana	Not covered per Minnesota state law.
Medical foods	Deplin; Gabadone	Medical foods are not covered by the Medicaid pharmacy benefit
Melatonin	Melatonin	Melatonin is not an FDA approved drug and is excluded from coverage.
Nutritional drinks and shakes	Boost; Ensure; Glucerna	Nutritional drinks and shakes are not part of the Medicaid pharmacy benefit. Certain enteral nutrition products are available through the durable medical equipment (DME) or medical supply benefit.
Probiotics	Align; Culturelle; Florajen	Probiotics are not FDA approved drugs and are excluded from coverage.
Promethazine with codeine	Promethazine with codeine	Limited cough and cold preparations are covered by fee-for-service Medicaid. Covered products include: Guaifenesin and dextromethorphan Guaifenesin tablets Guaifenesin and codeine Guaifenesin syrup Guaifenesin and hydrocodone syrup