Medicaid Prescription Drug Coverage

Since 1965, Medicaid has rendered support health programs and services for the United States’ most vulnerable population. Nowadays, this comprehensive health program provides services for families, children and seniors, individuals with disability that are eligible under Medicaid Eligibility Rules.  Prescription Drug coverage is one of the most crucial benefits you can get form Medicaid.

Not all states provide prescription drug coverage. Currently, only thirty-three states and the District of Columbia render this coverage for Medicaid members.  Each state has their own preference of selecting to offer prescription drug coverage to people in need of medical attention or to those who are not poor by cash aid standards, but need help with medical costs.

Medicaid drug benefits are extremely broad. The prescription drug coverage needed some revision for improving their services. That’s why every state has their own drug coverage that makes a comprehensive list of welfare, pharmacopeia or formularies that are in keeping with the federal regulations. There is no exception for these rules even for the Medicaid managed care organizations.

State Medicaid programs made important adjustments in their drug coverage guidelines over the past few years in response to the execution of Medicare prescription drug coverage (Part D). In January of 2006, Dual eligibles or individuals who are entitled to Medicare Part A and/or Part B and are eligible for some form of Medicaid benefit started getting their prescription drug coverage through the new Medicare Part D drug benefit instead of getting it from Medicaid. A fundamental benefit and an extra financial assistance to low-income recipients are the essential factors for this Act. Dual eligibles must join the Medicare Part D prescription drug benefit and low-income grant so they can continue with the drug coverage.

The enforcement of Modernization Act of 2003 (MMA) is very difficult, since many of its beneficiaries were not updated with the alterations in the new drug coverage. With the new law back in 2003, the states still face economic challenges until today.

Managed Care plans for Medicaid recipients are health-care delivery systems that incorporate the funding and delivery of health care. Medicaid ruling includes a wide exemption to the drug coverage rules.

The law grants the enrolling managed care system to expand and govern its own formulary. The states impose boundaries on the formularies of managed care same as that which the federal government enforce on states, if the prescription drugs are covered.

In most states, Over-The-Counter medications or drugs that can be bought without a prescription are covered under the Medicaid programs.  There are eight classes of non-prescription drugs such as topical products, digestive products, asthma, allergy, analgesics, H2 antagonists, and feminine products.

In some states they allowed some prescription drugs to be excluded in the program coverage.  These drugs include those used for fertility like Nafarelin; vitamins and mineral products such as multivitamins; drugs that handle treatment for anorexia, weight loss, or weight gain; some OTC products like acetaminophen, aspirin, and hydrocortisone; and anti-anxiety drugs like barbiturates and benzodiazepines.