Medicaid Foster Care Drug Carve-out List

Most of the medication costs for children residing in Foster Care facilities or group homes are covered by the Medicaid per diem paid to the facility. There are times however where the cost of the medication exceeds a cost sustainable by the per diem.

The drugs included on the list below may be carved out of the foster care per diem. This list is subject to change due to ongoing market activity and will be reviewed regularly. Coverage of high cost drugs not included on this list will be considered on a case by case basis. The agency should send such requests to the Office of Children and Family Services. All claims will be subject to Fee–For–Service Preferred Drug List (PDL) criteria and prior approval process if applicable.

Effective date 4/19/2019
Preferred agents in the following classes on the PDL
  • Anticholinergics / COPD Agents
  • Antipsychotics – Second Generation
  • Antipsychotics, Injectable
  • Anti–Virals – Topical
  • Benzodiazepines – Rectal
  • Biguanides
  • Central Nervous System (CNS) Stimulants
  • Corticosteroid/Beta2 Adrenergic Agent (Long–Acting) Combinations – Inhaled
  • Corticosteroids – Inhaled
  • Epinephrine, Self–injected
  • Growth Hormones
  • Hepatitis C Agents – Direct Acting Antivirals
  • Immunomodulators – Topical
  • Insulin – Long Acting
  • Insulin – Mixes
  • Insulin – Rapid–Acting
  • Other Agents for Attention Deficit Hyperactivity Disorder (ADHD)
  • Pancreatic Enzymes
  • Pulmonary Arterial Hypertension (PAH) Oral Agents, Other
Individual Drugs Listed below
  • Chlorpromazine
  • Lupron Depot
  • Onfi
  • Prograf
  • Budesonide inhalation suspension 1mg/2ml
  • Synagis
Antiretroviral Drugs used for HIV
  • Includes any antiretroviral drug indicated to treat HIV infection