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 MN Drug Lookup tool (hosted on the Prime Therapeutics portal.)
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:
|
| 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:
|