HOW TO ACCESS:
All Medicaid recipients except some who are Medicare/Medicaid eligible. Recipients who are full benefit dual eligible (Medicare/Medicaid) received their pharmacy benefits through Medicare Part D. Recipients enrolled in an MCO with only behavioral health services receive prescription benefits through the fee-for-service Medicaid program.
Covers prescription drugs, except:
- Cosmetic drugs (Except Accutane);
- Cough & cold preparations;
- Anorexics (Except for Xenical);
- Fertility drugs when used for fertility treatment;
- Experimental drugs;
- Compounded prescriptions;
- Drug Efficacy Study Implementation (DESI) drugs;
- Erectile Dysfunction (ED) Medications
- Over the counter (OTC) drugs, with some exceptions;
Co-payments ($0.50-$3.00) are required except for some recipient categories.
NO co-payments for the following recipients:
- under age 21
- Pregnant women
- Long Term Care.recipients
- American Indians/Alaska Natives
- Waiver categories
Prescription limits: 4 per calendar month (The physician can override this limit when medically necessary). Limits do not apply to recipients under age 21, pregnant women, or those in Long Term Care.
Prior Authorization is required for some drug categories if the medication is not on the Preferred Drug List (PDL). Children are not exempt from this process. The PDL can be accessed at www.lamedicaid.com.
For general pharmacy questions: 1-800-437-9101