People enrolled in Medicaid are limited to three 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:
- Diabetic supplies
- Family planning products
- Home health supplies
- Mosquito repellents
- Influenza vaccines
- Opioids for acute pain
- Smoking cessation products
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.
People enrolled in CHIP have unlimited prescriptions.
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.
The KHC program limits people to four 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.