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Refill Rules for Medicaid Prescriptions

Medicaid is a program which is regulated at the state level. Each state sets its own limits on the kinds of medical conditions which will be covered, under what circumstances and how much coverage is authorized in a given situation. Every state also has its own unique regulations for prescription dispensing and refills. These are typically broken down into categories such as how many refills are allowable in a given time frame, how often the refills can be obtained and how many different refills can be obtained per month.

  1. Size

    • Almost every state in the U.S. limits the size of a Medicaid prescription refill. Most specify an amount equal to a 30-day supply. Some states, such as Idaho, Nevada, Georgia, Minnesota and Montana allow a refill to be enough for 34 days. Others, such as Rhode Island and Massachusetts limit a refill to a strict 30 days. In the case of maintenance medications many states, including Colorado, Kentucky and New Hampshire allow for a single refill to cover 90 days. Rarely some states will cover larger refills, but these are considered on a case by case basis and are not routinely approved.

    Limits

    • Many states limit how many months of refills are allowable on a Medicaid prescription. According to a Congressional Research Service report on Medicaid prescriptions, many states, including Alabama, Georgia, Kansas and Mississippi have a maximum limit of five refills per prescription. Some may allow more than this, and some, like Connecticut, have different limits for oral contraceptives. Exceptions may be may for medications used for control of chronic conditions like high blood pressure or asthma. Many states also limit Medicaid refills to a monthly maximum number of prescriptions. North Carolina, Washington, Maine, and Arkansas are among these.

    Prescription

    • According to the U. S. Department of Health and Human Services, Department of Medicare and Medicaid Compliance, a new law effective October 1, 2008, regarding prescription forms used for Medicaid prescriptions, states that prescriptions must be written on a tamper-proof prescription pad in order to be covered under Medicaid. If the medicine is urgently needed, the pharmacist may fill the original prescription, but no refills can be issued under any circumstances unless the prescription is verified. If not verified, no refills will be allowed for that prescription.

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