Pharmacy Benefits of Medicaid: Important Things You Should Know

Medicaid is an American health scheme that covers the medical needs of hundreds of thousands of Americans who are incapable of taking care of their medical expenses by themselves.

This federal and state scheme takes care of outpatient, as well as inpatient services, physician services, health home services, and x-ray and laboratory services under their mandatory service module. The optional benefits of this health insurance include occupational therapy, physical therapy, case management, as well as prescription drugs.

Though optional, all the American states cover the pharmacy benefits for their beneficiaries, comprising underprivileged children, adults, and disabled citizens suffering from acute or chronic conditions.

The Medicaid Drug Rebate Program

Under this program, the Federal Law encourages the drug manufacturers who want to be a part of the program to repay a part of drug payment to the government. Medicaid then covers all the FDA-approved medicines manufactured by the manufacturer in question.

States and Medicaid Pharmacy Benefits

As already mentioned, Medicaid pharmacy benefits do not fall under the mandatory coverage. But, all the states include prescription drugs under Medicaid. Under federal rules, the states are given the liberty to regulate the pharmacy benefits under their Medicaid program.

To manage pharmacy benefits, the states depend on two factors-

• Utilizing managed care or pharmacy benefit managers (PBMS)
• Utilization controls

Branded, Generic, and Specialty Drugs

Generic drugs constitute the major part of drug utilization in Medicaid, but when it comes to drug expenses, branded drugs dominate. The majority of state Medicaid programs emphasize on generic drugs unless the prescriber insists on the medical importance of the branded variant.

Specialty drugs or blockbuster drugs are very expensive and need special administration. Medicaid covers these drugs irrespective of the financing challenges.

Drugs Covered By Medicaid

The over-the-counter medications mentioned here are covered with prescription by pharmacy benefits of Medicaid.

• Analgesic and Antipyretic

• Acetaminophen tablets/capsules, drops, suspension, and solution

• Aspirin suppositories and tablets

• Ibuprofen capsules, tablets, and suspension

• Antacids

• Aluminum hydroxide combo suspensions and tablets
• Calcium carbonate chewable tablets and capsules
• Calcium Carbonate/Mag Hydroxide chewable and suspension
• Simethicone capsule, chewable tablets, and liquid

• Anti-diarrheal drugs

• Bismuth chewable, tablet, and suspension

• Loperamide liquid and tablet

• Loperamide-simethicone chewable and tablet

• Antihistamines

• Cetirizine syrup, tablets, and chew tablets

• Chlorpheniramine tablets

• Diphenhydramine capsules, tablets, and liquid

• Anti-emetic /Anti-vertigo

• Meclizine tablets

• Dimenhydrinate tablets

• Cough and Cold

• Cromolyn nasal spray

• Dextromethorphan syrup

• Guaifenesin syrup, tablets

• Diabetes

• Alcohol wipes

• Bayer Brand Test Strips

• Glucose chew tablets

• Insulin 50-50, 70-30, N, and R

• Diagnostic Supplies

• Acetest reagent tablets

• Clinitest reagent tablets

• PTS Ketone test panel strips

• Family Planning

• Condoms

• Nonoxynol-9 film, foam, and gel

• Octoxynol gel

• H2 Antagonists

• Cimetidine OTC tablets

• Ranitidine OTC tablets

• Hematopoietic Agents

• Ferrous gluconate tablets

• Ferrous sulfate drops, elixir, and tablets

• Iron polysaccharide

• Laxatives

• Bisacodyl suppositories and tablets

• Calcium polycarbophil tablets

• Magnesium hydroxide suspension

• Minerals & Electrolytes

• Calcium with/without Vitamin D

• Magnesium gluconate tablets

• Magnesium oxide tablets

• Nasal Corticosteroids

• Flonase Allergy

• Proton Pump Inhibitors

• Esomeprazole OTC capsules

• Lansoprazole OTC capsules

• Omeprazole OTC tablets

• Sleep Aids

• Diphenhydramine

You can learn more about the drugs covered by Medicaid here.

Conclusion

The federal and state policymakers are taking sincere measures to control the cost of prescription drugs. The states are focussed on getting higher rebates from the manufacturers. Adopting these measures will help the policymakers to shape the current scheme and extend its benefits to those who depend on Medicaid for even the smallest medical needs.

(Disclaimer: Devdiscourse's journalists were not involved in the production of this article. The facts and opinions appearing in the article do not reflect the views of Devdiscourse and Devdiscourse does not claim any responsibility for the same.)