3.1.1 Medicaid

People enrolled in Medicaid are limited to three (3) prescriptions per month except for:

  • Children under the age of 21
  • People enrolled in managed care
  • People enrolled in eligibility waiver programs

Drugs and products not counted as part of the three-prescription limit include:

  • Family planning drugs
  • Flu vaccines
  • Opioids for acute pain
  • Diabetic supplies
  • Smoking cessation products
  • Home health supplies
    • Refer to the Home Health Supplies chapter of this manual for more information about these products
  • Mosquito repellents
    • Refer to the Mosquito Repellant chapter of this manual for a list of these products

3.1.1.1 Medicaid  

Payment for up to a six-month supply may be allowed for adults with monthly prescription limitations dependent on the drug prescribed.  Quantities should not exceed a one-month (34-day) supply for people with an unlimited number of prescriptions per month.

3.1.2 CHIP

People enrolled in CHIP have unlimited prescriptions.

3.1.3 CSHCN

People enrolled in the CSHCN Services Program have unlimited prescriptions.  The CSHCN Program is limited by the availability of appropriated funds.  Upon notification to eligible people and providers, services may be adjusted periodically depending upon the current availability of funds. If a person is dually-enrolled in Medicaid and CSHCN, the Medicaid benefit should be used first, including those people limited to 3 prescriptions per month.

3.1.4 KHC 

The KHC program limits people to four (4) prescriptions per month.  The number of prescriptions per month the program pays per person is based on available KHC funds, and the number of prescriptions covered may change depending on budget limitations.  Notification will be sent 30 days in advance if the prescription number limitation changes.