MD

"10.09.67.04...
D. Drug Formulary...
 (2) An MCO shall include in its formulary drugs that are appropriate for medical management, safe, and effective.
 (3) An MCO shall expand its formulary, as needed, to include drugs that are equivalent to new drugs approved by the federal Food and Drug Administration, and which are deemed to be appropriate, safe, and efficacious in the medical management of the MCO's enrollees." Maryland COMAR 10.09.67.04.

NJ

"10.14 The contractor shall provide all medically necessary legend and non-legend drugs covered by the Medicaid program and ensure the availability of quality pharmaceutical services for all enrollees. The use of a formulary may be permitted only with compliance with the following minimum requirements: ...

C. The formulary for the Medicaid pharmacy benefit and any revision thereto must be reviewed and approved by DMAHS.

D. The formulary must include the FDA approved drug products.In addition, the formulary must be revised periodically to assure compliance with this requirement." New Jersey Contract, pages 57-58.

WA

"I. DRUG FORMULARY USE [UM 10]
The contractor must have processes to ensure its drug formulary, if any, is based on sound clinical evidence and is reviewed and updated at specific intervals. The contractor must develop its formulary with input from actively practicing practitioners and make the formulary available to its practitioners. The contractor with a closed formulary must have an exceptions policy in place. (F)

 1. The contractor's formulary, whether open or closed, must be based on sound clinical evidence, and the contractor must specify how to apply the formulary in an appropriate manner based on the needs of the individual patients. [UM 10.1] (F)

 2. If the contractor restricts pharmacy benefits to a closed formulary, it must have an exceptions policy and procedure, comparable to its appeal policy and procedure, through which it covers a prescription drug not included in the formulary." Washington Contract, QIP-2000 Standards, pages 16-17.