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Kentucky
Data Last Updated: 04-16-2024
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Coverage Values:
- Y : Yes, covered for all Medicaid enrollees
- N : Not covered for Medicaid enrollees
- * : Coverage varies across state Medicaid plans
Barrier Values:
- Y : Yes; barrier exists in all the state Medicaid plans that cover the specified asthma service or treatment
- N : No; barrier does not exist in any state Medicaid plan that covers the specified asthma service or treatment
- * : The barrier exists in some of the state Medicaid plans that cover the specified asthma service or treatment
- NAv : Barrier information is not available for the state Medicaid plans that cover the specified asthma service or treatment
- N/A : The barrier is not applicable for the specified asthma service or treatment
Barriers:
- AL : Age Limit (coverage for individuals under a certain age)
- CO-PAY : Copayment (a fee a patient is responsible for to receive treatment or service)
- DME : Durable Medical Equipment (treatment or service covered as a DME benefit)
- EC : Eligibility Criteria (indicates a patient needs to meet certain criteria before receiving a treatment or service)
- PA : Prior Authorization (service must be approved before patient receives care)
- QL : Quantity Limit (restricting amount of service or treatment in a specified time)
- ST : Step Therapy (a treatment or service can be received only after other forms of therapy have been tried)
Other
- + = : either all plans have no quantity limit or at least two inhalers per month or at least 2 valved-holding chambers per year are covered by all plans>
Quick Relief Medications
Component | Coverage | AL | CO-PAY | DME | EC | PA | QL | ST |
---|---|---|---|---|---|---|---|---|
Albuterol Sulfate (inhaled)+ | Y | N | * | N/A | N/A | N | Y | N |
Albuterol Sulfate (nebulized) | Y | N | * | N/A | N/A | N | Y | N |
Levalbuterol (inhaled)+ | Y | N | * | N/A | N/A | Y | Y | Y |
Levalbuterol (nebulized) | Y | N | * | N/A | N/A | Y | Y | Y |
Controller Medications
Component | Coverage | AL | CO-PAY | DME | EC | PA | QL | ST |
---|---|---|---|---|---|---|---|---|
Budesonide (Nebulized) | Y | N | * | N/A | N/A | N | Y | N |
Beclomethasone | Y | N | * | N/A | N/A | Y | N | Y |
Ciclesonide | Y | N | * | N/A | N/A | Y | Y | Y |
Fluticasone proprionate | Y | N | * | N/A | N/A | N | Y | N |
Mometasone furoate | Y | N | * | N/A | N/A | N | Y | N |
Methylprednisolone | Y | N | * | N/A | N/A | N | N | N |
Prednisolone | Y | N | * | N/A | N/A | N | N | N |
Prednisone | Y | N | * | N/A | N/A | N | N | N |
Salmeterol xinafoate | Y | N | * | N/A | N/A | N | Y | N |
Tiotropium Bromide | Y | N | * | N/A | N/A | Y | Y | Y |
Fluticasone propionate and salmeterol | Y | N | * | N/A | N/A | N | Y | N |
Mometasone furoate and formotorol fumarate | Y | N | * | N/A | N/A | N | Y | N |
Budesonide and formotorol fumarate | Y | N | * | N/A | N/A | N | Y | N |
Fluticasone furoate and vilanterol | Y | N | * | N/A | N/A | Y | Y | Y |
Fluticasone furoate, umeclidinium and vilanterol | Y | N | * | N/A | N/A | Y | Y | Y |
Cromolyn | Y | N | * | N/A | N/A | N | N | N |
Montelukast | Y | * | * | N/A | N/A | N | Y | N |
Zafirlukast | Y | N | * | N/A | N/A | Y | Y | Y |
Zileuton | Y | N | * | N/A | N/A | Y | Y | Y |
Theophylline | Y | N | * | N/A | N/A | N | N | N |
Omalizumab | Y | NAv | * | N/A | NAv | N | Y | N |
Devices
Component | Coverage | AL | CO-PAY | DME | EC | PA | QL | ST |
---|---|---|---|---|---|---|---|---|
Nebulizer | Y | NAv | N | * | N/A | N | * | N/A |
Peak-Flow Meter | Y | NAv | N | * | N/A | N | N | N/A |
Valved-Holding Chamber | Y | N | N | * | N/A | N | * | N/A |
Allergen Testing
Component | Coverage | AL | CO-PAY | DME | EC | PA | QL | ST |
---|---|---|---|---|---|---|---|---|
Allergy Testing | Y | NAv | NAv | N/A | N/A | N | * | N/A |
Allergen Treatment - Allergen Immunotherapy
Component | Coverage | AL | CO-PAY | DME | EC | PA | QL | ST |
---|---|---|---|---|---|---|---|---|
Allergen Immunotherapy | Y | NAv | NAv | N/A | N/A | N | NAv | N/A |
Lung Function Testing
Component | Coverage | AL | CO-PAY | DME | EC | PA | QL | ST |
---|---|---|---|---|---|---|---|---|
Spirometry | Y | NAv | NAv | N/A | NAv | N | NAv | N/A |
FeNo Testing | Y | NAv | NAv | N/A | NAv | N | NAv | N/A |
Home Visit
Component | Coverage | AL | CO-PAY | DME | EC | PA | QL | ST |
---|---|---|---|---|---|---|---|---|
Home Visit and Intervention | NAv | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
Self-Management Education
Component | Coverage | AL | CO-PAY | DME | EC | PA | QL | ST |
---|---|---|---|---|---|---|---|---|
Self-Management Education | Y | NAv | NAv | N/A | NAv | N | NAv | N/A |
Data was collected from the following source documents and verified with state Medicaid offices when possible.
- KY Medicaid OTC Drug List 7/2023
- KY Anthem Provider Lookup Tool (Accessed 12/2023)
- Humana Healthy Horizons in KY Medicaid Member Handbook 5/2023
- Humana Kentucky Medicaid Pharmacy Program (Accessed 12/2023)
- Passport Health Plan by Molina Healthcare Member Handbook 12/2022
- Passport Health Molina Prescription Drugs (Accessed 12/2023)
- Passport Health Plan by Molina Healthcare Pre-Auth Check (Accessed 12/2023)
- Molina Strategies for Addressing Asthma in Homes 2018
- Molina Provider Manual 2024
- UnitedHealthcare Community Plan of Kentucky Member Handbook 4/2023
- UnitedHealthcare Community Plan of Kentucky Details (Accessed 12/2023)
- WellCare of Kentucky Enrollee Handbook 1/2023
- WellCare Pharmacy Services (Accessed 12/2023)
- WellCare Search for a Drug (Accessed 12/2023)
- Kentucky Medicaid Pharmacy Provider Billing Manual 1/2022
- Kentucky Medicaid Drug Info Preferred Drug List 11/2023
- Kentucky Medicaid Drug Info Maximum QL List 11/2023
- Kentucky Medicaid Drug Info Prior Authorization Criteria 11/2023
- KY Medicaid Fee Schedules DME 11/2023
- KY Medicaid Fee Schedules Physician 11/2023
- Aetna KY Medicaid Member Handbook 2023
- Aetna KY Formulary Search (Accessed 12/2023)
- Aetna Better Health of Kentucky PA Lookup (Accessed 12/2023)
- Anthem BlueCross BlueShield Kentucky Medicaid Member Handbook 1/2023
- Anthem BlueCross BlueShield Kentucky Medicaid Pharmacy Benefits (Accessed 12/2023)
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Component | Coverage | AL | CO-PAY | DME | EC | PA | QL | ST |
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