Does Medicaid Cover Prescriptions [Get The Facts]

Medicaid is one of the greatest options for many low-income families, providing access to a wide range of medical services; but, are prescription drugs covered?

One of the most perplexing aspects of Medicaid is that it varies by state, and many users are unaware of what is truly covered. So, whether you’re new to this government program or simply want the most up-to-date information, keep on reading to learn more.

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What is covered by Medicaid?

Medicaid was established to assist people in need and low-income families. Children under the age of 21, pregnant women, and the elderly are given special consideration.

Medicaid covers a wide range of services, including doctor’s visits, nursing homes, hospital charges, long-term care fees, and much more. 

While Medicaid is governed by federal law, each state has the authority to modify the program as they see proper. This is one of the reasons why individuals frequently do not understand how Medicaid works in their country and need further assistance.

You can learn all you need to know about Medicaid by:

  • Visiting our website which has all the relevant information;
  • Calling the Medicaid representative in your country;
  • Calling your medical insurance company;

Does Medicaid cover prescriptions?

The basic answer is that medicines are covered by Medicaid, but there are several crucial factors you should be aware of.

While prescription medications are optional coverage in each state, all 50 states have agreed to the legislation requiring Medicaid to cover them. However, each state has its restrictions, and you should check to see what the limitations are in your country.

Depending on where you reside, you may be covered for all of the medications, although there may be a modest co-payment required in some situations.

Let’s see what are the specifics.

What medications are covered by Medicaid?

Medicaid covers a wide range of medications, including those not covered by Medicare, such as drugs for:

  • Fertility;
  • Anorexia;
  • Weight loss;
  • Cosmetic reasons;
  • Vitamins and minerals on prescription (prenatal vitamins excluded);
  • Over-the-counter medications.

Keep in mind that each state will have its formulary or list of prescription medications covered by Medicaid. When it comes to prescription medications, there are two types of lists: preferred lists and non-preferred lists.

Different medicines can appear on such lists depending on your state’s laws and regulations. In most circumstances, the less expensive and generic form of each medicine will be favored. 

If you require medication that is not on the recommended list, you may be granted special authorization. This permission means that you will be able to obtain the medicine, but it will stay on the list of drugs that are not favored.

When the state has a made list, they can demand a co-payment of up to 20% from the patient.

Is it possible for Medicaid to cover brand-name drugs?

Brand-name pharmaceuticals are typically not the first choice, and you can only be insured for them if there are no other options. 

As a condition of coverage under the Medicaid Drug Rebate Program, states will get the best price given by manufacturers.

Each state’s budget is different, and brand-name pharmaceuticals are always more expensive than generic brands. Even though they are chemically identical, brand names will only be reimbursed by Medicaid if they are so new that there are no substitute medications.

Is it true that Medicaid covers over-the-counter medications?

Yes, provided the patient has a doctor’s prescription, Medicaid will cover over-the-counter medications. This sort of medication will be accessible for purchase regardless of whether the prescription is spoken, written, or transmitted through electronic messaging.

Many over-the-counter medications are covered by Medicaid since they are not deemed risky or dangerous. However, keep in mind that the medicine must be manufactured by a pharmaceutical business that is a participant in the Federal Drug Rebate Program.

Here are a few examples of such medications:

  • Aspirin
  • Pseudoephedrine
  • Permethrin Lotion
  • Acetaminophen
  • Zinc Oxide Treatment

How much do prescriptions cost with Medicaid?

Knowing how much a prescription pill will cost is a difficult estimate since it is dependent on a number of factors. This is why states control preferred and non-preferred lists and look for the most cost-effective solutions. 

In this manner, practically all prescriptions may be completely paid by Medicaid.

However, the state is permitted to levy a co-payment of up to 20% of the non-preferred prescription medicine price.

How many prescriptions does Medicaid cover per month?

This is determined by the state you live in and the medication you are prescribed. Some states are more lenient, allowing Medicaid to cover additional medicines monthly. However, there is no universal rule that can assist you in answering this issue.

The best thing to do in this situation is to consult your local Medicaid agent or your insurance provider since they work closely together and are aware of all the tiny print data you may want.

Is Medicaid accepted at all pharmacies?

No, not every pharmacy accepts Medicaid.

Prescription medicines, like any other medical treatment available via Medicaid, will be covered only in certain pharmacies. Looking for a suitable drugstore online or phoning your Medicaid agent is the easiest method to discover it.

How long does Medicaid take to approve a prescription?

The Medicaid agency in each state is required by federal law to handle the request within 24 hours. However, keep in mind that in some situations, they are also required to provide consumers with 72-hours’ worth of medicine if the situation is urgent.

Final Thoughts

Medicaid will cover prescription medications in all 50 states, although the laws and restrictions vary by jurisdiction. This is why you should read our detailed post for basic information on Medicaid-covered medicines and talk with an agent for further specifics.

As long as the prescription is on the list of recommended pharmaceuticals, your Medicaid plan will most likely pay it completely. Even if you have to pay a portion of the cost out of your own pocket in some situations, the price will be greatly reduced.

David Duford
Author: David Duford