Eligibility Requirements
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Covered Medications
The following medications are covered by Medicaid Prescription Drug Benefit:
How to Apply
- Speak with your healthcare provider about Medicaid Prescription Drug Benefit. Your doctor, nurse, or social worker can help determine if you qualify.
- Gather required documents: proof of income (tax return, pay stubs, or Social Security statement), valid prescription, and proof of U.S. residency.
- Submit your application online or by mail. Visit the program website below or call the program hotline for assistance.
- Wait for a decision. Approval times and delivery (to your home, your prescriber or a pharmacy) vary by programme, and the programme will tell you how your medicine will arrive.
Check If You Qualify
Use our free Assistance Finder tool to check eligibility for Medicaid Prescription Drug Benefit and other programs that may help reduce your medication costs.
Open Assistance FinderSources and standards behind this page
Drug coverage in the United States is governed by published rules rather than by any one insurer's summary, and the sources below are the primary ones. They are linked so a reader can check a claim without taking this page's word for it.
- FDA Orange Book publishes the therapeutic-equivalence ratings that decide whether a generic may be substituted for a brand-name drug.
- FDA generic drug facts sets out what "generic equivalent" means and what a manufacturer must prove.
- CMS prescription drug coverage defines the rules a Medicare drug plan formulary must follow and how it may change mid-year.
- Medicare.gov drug coverage (Part D) states what a Part D plan is required to offer a member.
- CMS prescription drug appeals documents the coverage-determination and exception process when a drug is denied.
- Medicare Plan Compare is the official tool for checking what a specific plan charges for a specific drug at a specific pharmacy.
- Drugs@FDA is the federal database of approved drug products, which establishes whether a covered product exists and in what form.
- DailyMed carries the current FDA labeling for every marketed drug product, including approved strengths and forms.
- MedlinePlus drug information is the National Library of Medicine's consumer reference for what a medication is and how it is used.
- FTC report on pharmacy benefit managers documents how the middlemen between an insurer and a pharmacy shape what a plan actually covers.
- National Library of Medicine maintains the drug and health databases the sources above draw on.
This page describes how coverage and formularies work. It is not medical advice, and a reader's own plan documents and prescriber decide what applies to them.
Frequently Asked Questions
Medicaid must cover most FDA-approved drugs from manufacturers that participate in the Medicaid Drug Rebate Program. States can maintain preferred drug lists, but must provide a process for obtaining non-preferred drugs when medically necessary.
Most Medicaid programs charge copays of $0-3 per prescription. Some states have no copays at all. Copays for preferred generics are typically $1-2, while brand-name drugs may cost $3-4.
Apply through your state's Medicaid office, at HealthCare.gov during open enrollment, or in person at a local Department of Social Services. Many states offer year-round Medicaid enrollment for those who qualify.
Related Resources
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