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Prescriptions
Prescription Drug benefit eligibility, maximum number of days supplied, prior authorization requirements, and Copays
Prescriptions

Prescription Drugs

Who is Eligible? All Medicaid beneficiaries except those who are eligible to enroll in Medicare Part D; Part D-eligible beneficiaries can only receive Medicaid coverage for medications that are excluded from Medicare Part D coverage

How often? Less than a 34 day supply dispensed at a time for drugs to treat acute conditions.  Less than a 120 day supply dispensed at a time for drugs to treat chronic conditions.

What is required? Prior authorization required for name-brand prescription drugs when generic ones are available.  Learn more about prescriptions here.

What are my costs? $3 for prescription drugs requiring prior authorization (non-pregnant and non-institutionalized individuals over age 21); $2 copay for most name-brand drugs (non-pregnant and non-institutionalized individuals over age 21); $0 copay for hospice consumers and medications for emergency services and family planning services.