State Medicaid Prescription Limits
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As of July 1, 2019
| Location | Monthly or Other Limit on Number of Prescriptions in FFS | If Yes, Limit Description | Prior Authorization or Appeals Process to Override | Exemptions to Limit | If Yes, Exemptions Description | Requirement for MCOs to Apply Same Policies for Limits and Exemptions |
|---|---|---|---|---|---|---|
| United States | Yes: 13, No: 37, NR: 1 | Yes: 9, No: 4 | Yes: 11, No: 2 | |||
| Alabama | Yes | Limit of 5 prescriptions per month for adults. | No | Yes | Antiretrovirals, anticonvulsants, antipsychotics, maintenance drugs | N/A |
| Alaska | No | |||||
| Arizona | No | |||||
| Arkansas | Yes | Limit of 3 presciptions per month for adults with extension of benefits for up to 6 prescriptions maximum. | No | Yes | Medications for tobacco cessation, family planning | No |
| California | Yes | Limit of 6 prescriptions per month. | Yes | Yes | Nursing facility patients, adult and pediatric subacute care patients Family planning drugs, drugs for the treatment of Acquired Immune Deficiency Syndrome (AIDS) or AIDS-related conditions, cancer drugs Claims for newborns when the baby uses the mother's identification number, claims that must be submitted on paper (claims with required attachments) | No |
| Colorado | No | |||||
| Connecticut | No | |||||
| Delaware | No | |||||
| District of Columbia | No | |||||
| Florida | Yes | Limit on controlled substances of 4 fills per month for all recipients excluding recipients with a diagnosis of sickle cell or cancer. | Yes | Yes | Recipients with sickle cell or cancer recipients may receive 6 fills per month. | Yes, in part |
| Georgia | Yes | Limit of 5 narcotic prescriptions per month. | Yes | No | No | |
| Hawaii | No | |||||
| Idaho | No | |||||
| Illinois | Yes | Limit of 4 presciptions per month, additional prescriptions require review. | Yes | Yes | Antipsychotics, antirejection drugs, antiretrovirals, antineoplastics | No |
| Indiana | No | |||||
| Iowa | No | |||||
| Kansas | Yes | Limit of 4 single-source drugs per month. | Yes | Yes | EPSDT beneficiaries, antiretroviral drugs, preferred PDL drugs, anti-rejection drugs used for transplant patients, state specified anti-emetics and chemotherapy drugs, interferons, immune globulins, antihemophilic drugs, mental health drugs, all contraceptives | Yes, in part |
| Kentucky | No | |||||
| Louisiana | Yes | Limit of 4 prescriptions per month. | Yes | Yes | Beneficiaries under 21, beneficiaries in Long Term Care, pregnant women | Yes, in part |
| Maine | No | |||||
| Maryland | No | |||||
| Massachusetts | No | |||||
| Michigan | No | |||||
| Minnesota | No | |||||
| Mississippi | Yes | Limit of 6 prescriptions per month with no more than 2 brand-name drugs. | No | Yes | Preferred brands on the PDL do not count toward the 2 brand limit. Limit does not apply to beneficiaries in a LTC facility. EPSDT beneficiaries may receive prescriptions beyond the limit with prior authorization. | Yes |
| Missouri | No | |||||
| Montana | No | |||||
| Nebraska | No | |||||
| Nevada | No | No | ||||
| New Hampshire | No | |||||
| New Jersey | No | |||||
| New Mexico | No | No | ||||
| New York | No | |||||
| North Carolina | No | N/A | ||||
| North Dakota | No | Yes | ||||
| Ohio | No | |||||
| Oklahoma | Yes | Limit of 6 prescriptions per month with no more than 2 brand-name drugs. For HCBS waiver recipients, limit of 3 brand-name drugs and 10 generic drugs per month. | Yes | Yes | Antiretrovirals, hemophilia medications, oncology drugs, birth control, smoking cessation products | N/A |
| Oregon | No | |||||
| Pennsylvania | No | |||||
| Rhode Island | No | |||||
| South Carolina | No | |||||
| South Dakota | No | N/A | ||||
| Tennessee | Yes | Limit of 5 prescriptions per month with no more than 2 brand-name drugs for adults 21 and over who are not in an institution or HCBS waiver. | Yes | Yes | Antidepressants, antineoplastics, antiparkinsonian agents, antitubercular agents,antivirals and antiretrovirals, cardiovascular agents, clotting factor, contraceptives, insulins, oral hypoglycemics, dialysis medications, flu vaccine, hematopoietic agents, Hepatitis C drugs, immunosuppressives, iron preparations, lipotropics, long-acting antipsychotics, respiratory drugs, smoking cessation products, thyroid hormones, transplant agents, and other miscellanious agents (MAT therapy, narcan, asthma and diabetics supplies, inhaled antibiotics, and pancreatic enzymes) | N/A |
| Texas | Yes | Limit of 3 prescriptions per month for adults. | No | No | No | |
| Utah | NR | |||||
| Vermont | No | |||||
| Virginia | No | |||||
| Washington | No | |||||
| West Virginia | No | |||||
| Wisconsin | Yes | Limit of 5 opioid prescription fills per month. | Yes | Yes | Schedule II - V opioids are included, with the exception of suboxone film and tablet, buprenorphine tablet, methadone solution , and opioid antitussive liquid | N/A |
| Wyoming | No | N/A |