Does Medicaid Cover Prescriptions? – Overview
The short answer is yes, but coverage varies from state to state.
If you’re an enrollee with a Medicaid card or an eligibility letter confirming that you’re a Medicaid recipient, you can buy prescriptions drugs that Medicaid covers.
However, before you go out and start getting prescription medication with your Medicaid cover, you need to know the specific drugs that Medicaid can pay for and where you can purchase these drugs.
Medicaid will pay for prescription meds bought from specific drug stores. The only way you can find out whether your favorite pharmacy is approved to sell drugs by Medicaid is to contact your local Medicaid office or speak to the pharmacy directly.
So as long as you’re getting drugs covered by Medicaid, you’ll be visiting a drug store participating in the Medicaid program.
You can use your Medicaid card when you get there, but if you enrolled recently and don’t have the card yet, you can use your eligibility letter.
The eligibility letter is a form of ID to give you access to Medicaid benefits for prescription meds and other services.
How Many Prescriptions Does Medicaid Pay for in A Month?
The rules and regulations vary from state to state about how many prescriptions Medicaid can pay for each month.
Some states are more generous than others, and the laws are frequently changing in response to the introduction of new prescription medication or increases or decreases in aid.
Contact your local Medicaid office or representative to fully understand the details surrounding prescription meds and the number of times that Medicaid will cover them each month.
Depending on which prescription meds you need, the number of tablets or capsules you’ll get will vary depending on the meds.
State Medicaid outlets list their preferred drugs along with their limits to make these limits clear and crisp for both patients and pharmacies.
So, ensure you check directly with your coverage provider to see the drugs covered under your plan.
Do All Pharmacies Accept Medicaid Payment?
No, only pharmacies participating in the Medicaid program accept this form of payment.
However, just like with hospitals and physicians, it’s vital that you check and confirm if your favorite pharmacy is listed in your State Medicaid preferred pharmacy list.
It’s essential to ask and get clarification because getting prescription meds in a pharmacy that is not approved by Medicaid can result in you having substantial out-of-pocket costs and less efficient use of your Medicaid health plan.
The first place to check if your favorite or local pharmacy will accept Medicaid coverage is your State Medicaid’s list of providers.
Most state Medicaid programs have a list posted on their websites that can be accessed at any time.
Suppose the pharmacy you constantly visit isn’t Medicaid-approved. In that case, it’s possible to continue getting your prescription meds from them using Medicaid for a short time after you enroll for Medicaid coverage.
However, after you receive your card, it will be necessary that you find a pharmacy approved by Medicaid so that your coverage isn’t interrupted.
Does Medicaid Pay for OTC Medication?
Medicaid will pay for OTC (over-the-counter) meds if you have gotten a prescription for the meds from a doctor either verbally, in writing, or via electronic text.
To get Medicaid coverage for OTC drugs, the drugs have to be made by a pharmaceutical enterprise that contributes to the FDRP (Federal Drug Rebate Program).
Although Medicaid covers OTC meds in the monthly drug benefit limit, all these drugs are considered to be generic even if the name of the company that manufactures the drug is indicated.
A list of approved OTC meds is available on Medicaid.ms.gov.
Individuals who are enrolled in Medicaid Family Health Plus and Managed Care can be able to get pharmacy benefits via their Medicaid Managed Care plan directly.
OTC meds that are not included on the list of Medicaid-approved meds can still be covered if the recipient is under 21 years and has prior approval “Children’s Medical Necessity” that’s part of EPSDT (Early and Periodic Screening, Diagnostic and Treatment) coverage.
Examples of OTC meds that Medicaid pays for include:
3. Permethrin Lotion.
5. Zinc Oxide Treatment.
As a general rule, Medicaid will only pay for generic versions of OTC meds. However, in some instances, branded drugs could be cheaper.
Medicaid will not pay for OTC meds to prevent discomfort or pain.
Medicaid will also not pay for prescription meds meant for coughs or colds, and although Medicaid doesn’t pay for OTC vitamins, the program will pay for recommended prenatal vitamins.
What Are the Out-Of-Pocket Costs for Prescriptions with Medicaid Coverage?
The precise method used to calculate the out-of-pocket costs for prescription meds covered by Medicaid is somewhat complex.
The method is based on various elements and factors, so it can be difficult to know or understand the prices of different prescriptions covered by Medicaid.
The co-payments for prescriptions meds covered by Medicaid are as follows:
1. OTC (Non-Prescription) Meds – $0.50.
2. Generic Prescription Meds – $1.00.
3. Branded Prescription Meds – $3.00.
Most drugs on the ‘preferred list’ of most State Medicaid programs are the most affordable ones. The list also includes the most practical and effective meds available.
When pricing prescription meds covered by Medicaid, a balance must be struck to enable pharmaceutical enterprises and pharmacies to cover their expenses.
It also enables them to keep the price low enough such that the government can afford to almost cover these prescription meds fully on behalf of the recipients.
As a result, the cost of prescription meds varies a lot.
The details of what Medicaid covers about prescription drugs vary from state to state. As a result, be sure to always talk to your physician about the meds you need and Medicaid’s cost structure for these meds.
In addition, note that the law forbids private billing of Medicaid beneficiaries, so if this happens, contact your local Medicaid office as soon as possible.