Does Medicaid cover prescriptions?
Last verified:
Yes. Pharmacy is technically optional, but every state covers outpatient prescription drugs, with a preferred drug list, prior authorization and small copays. Federal rule: optional, but adopted by all states.
What federal law says
Medicaid.gov states it directly: although pharmacy coverage is an optional benefit under federal Medicaid law, all states currently provide coverage for outpatient prescription drugs to all categorically eligible individuals and most other enrollees. The Medicaid Drug Rebate Program means that once a manufacturer signs the federal rebate agreement, its drugs are covered, subject to the state's controls.
Those controls are the preferred drug list, prior authorization for non-preferred drugs, quantity limits, and generic substitution. States may also exclude the drug classes in section 1927(d)(2): drugs for weight loss, cosmetic purposes, cough and cold, fertility, erectile dysfunction, and non-prescription drugs, among others.
Copays are limited by federal rules and are typically $1 to $8 per prescription, with children, pregnant women and people in institutions exempt. For enrollees at or below the poverty line, a pharmacy cannot refuse to fill a prescription because the copay cannot be paid, though the copay remains owed.
Children under 21
Children's prescriptions are covered under EPSDT, and states may not charge copays for children.
What to ask your state plan
- Ask the pharmacist to run a prior authorization request rather than telling you the drug is 'not covered'; most denials are non-preferred status, not exclusion.
- The state's preferred drug list is public and searchable.
- Find your state's agency, program name and phone on Medicaid by state.
Related questions
- Does Medicaid cover ambulance rides?
- Does Medicaid cover transportation to appointments?
- Does Medicaid cover nursing home care?
Common questions
Does Medicaid cover prescriptions?
Yes. Pharmacy is technically optional, but every state covers outpatient prescription drugs, with a preferred drug list, prior authorization and small copays.
Does Medicaid cover prescription drugs for children?
Children's prescriptions are covered under EPSDT, and states may not charge copays for children.
How do I find out whether my state's Medicaid covers prescription drugs?
Three places. Your plan's member handbook or benefit summary, which lists the covered services and limits; the state Medicaid agency's provider manual for the service, which is public and states the medical-necessity criteria; and the member services line on your card, which can run a coverage check for a specific procedure code. Our state pages list each agency's phone and portal.
Sources
- medicaid.gov: prescription drugs
- Social Security Act section 1927(d)(2) (drugs a state may exclude)
- medicaid.gov: mandatory and optional Medicaid benefits
Gov-Grants.org is an independent guide, not a carrier and not a government agency. We never charge fees, and every fact above links to its source with the date we checked it. Program details change; confirm on the official site before applying.