A. Agents when used for anorexia or weight gain. Coverage of anorexiants for other than weight loss requires medical justification. FDA-approved drug therapies and agents for weight loss, when preauthorized, will be covered for recipients who meet the strict disability standards for obesity established by the Social Security Administration in effect on April 7, 1999, and whose condition is certified as life threatening, consistent with Department of Medical Assistance Services' medical necessity requirements, by the treating physician. Select agents when used for anorexia, weight loss, or weight gain will be covered as listed in the state's provider manual.

B. Agents when used for cosmetic purposes or hair growth.

1. Minoxidil shall not be covered when prescribed for hair growth or other cosmetic purposes.

2. Agents containing hydroquinone or its derivatives which are used solely for depigmentation of the skin.

Select agents when used for cosmetic purposes or hair growth will only be covered if such agents are determined to be medically necessary, AND as listed in the state's provider manual.

C. Agents used to promote fertility.

D. Expired drugs. Drugs dispensed past the labeled expiration date.

E. DESI Drugs. The Program shall not provide reimbursement for drugs determined by the Food and Drug Administration (FDA) to lack substantial evidence of effectiveness.

F. Nonlegend drugs. Nonlegend drugs, with those exceptions shown in 12VAC30-50-100 et seq., shall not be covered. Select non-legend drugs will be covered as listed in the state’s provider manual.

G. Select agents when used for the treatment of sexual and erectile dysfunction will only be covered to treat a condition, other than sexual or erectile dysfunction, AND as listed in the state's provider manual.