Medicaid and Part D

Section IX.c. Medicaid and Medicare
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If you have Medicare and Medicaid, you will usually get your drugs covered by the Medicare prescription drug benefit (Part D) and the Extra Help program. Extra Help is the federal program that pays for most of the costs of Medicare drug coverage.  In some limited cases, Medicaid may cover drugs that Medicare does not cover.

In many states, Medicaid covers some drugs that are excluded from Medicare coverage by law. Drugs excluded from Medicare coverage by law that may be covered by your state’s Medicaid program include:

  • Drugs for:
    • Anorexia, weight loss or weight gain
    • Fertility
    • Cosmetic purposes or hair growth
    • Relief of the symptoms of colds, like a cough and stuffy nose
  • Prescription vitamins and minerals (except prenatal vitamins and fluoride preparations)
  • Non-prescription drugs (over-the-counter drugs)

In some states, Medicaid covers additional medications for people with Part D.

You will only pay a small copay for prescriptions that are covered by Medicaid in your state. Keep in mind that all states have a Medicaid formulary, or list of covered drugs. A medication usually must be on the Medicaid formulary in order for it to be covered for you. If you need a prescription that is not on the Medicaid formulary, you may still be able to have it covered for you. Speak to your pharmacist about which drugs Medicaid will cover for you. For general information you can also call your Medicaid office or your State Health Insurance Assistance Program (SHIP). You can get the number for your SHIP by calling 800-MEDICARE.


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