Medicaid

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

• Children under 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 the following:

• COVID-19 oral antivirals
• COVID-19 test kits
• COVID-19 vaccines
• 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.

CHIP

People enrolled in CHIP have unlimited prescriptions, with a few exclusions, including the following:

• Contraceptive medications prescribed only for the purpose of primary and preventative reproductive health. Refer to the Family Planning Products section for more information. 
• Medications for weight loss or gain

CSHCN

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

KHC 

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.  KHC will send a notification 30 days in advance if the prescription number limitation changes.

The federal Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2020 became effective Jan. 1, 2023. The Act extends lifetime Medicare coverage of immunosuppressant drugs for Medicare-eligible kidney transplant recipients indefinitely. This Act only provides coverage of immunosuppressant drugs and does not provide full healthcare coverage. Refer to the Medicare End Stage Renal Disease website for more information.