Imagine walking up to the pharmacy counter expecting your Medicaid coverage to keep your prescription affordable, only to be told you owe $450 for a 30-day supply. Unfortunately, that scenario is becoming more common, particularly for brand-name medications, specialty drugs, and prescriptions that require prior authorization or aren’t fully covered by a state’s Medicaid formulary.
While Medicaid covers outpatient prescription drugs in every state, each state has broad flexibility to manage its own preferred drug list, prior authorization requirements, and pharmacy policies. That means the same medication may be covered differently depending on where you live.
