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quick facts about medicaid

Source: Centers for Medicare and Medicaid Services

Medicaid is a jointly funded, federal-state health insurance program for low-income and needy people. But, Medicaid is a state-administered program and each state sets its own guidelines regarding eligibility and services.

The Medicaid Program will pay for the patients' prescriptions only if the doctor accepts Medicaid.

The doctor must have a state medicaid number.

Patients must present a Medicaid ID card in order to get a prescription filled.

Medicaid patients 18 or older usually can only get 3 prescriptions filled in a month.

Medicaid patients under 18 years are allowed to have more than 3 prescriptions per month.

You should check the medicaid preferred drug list with the Health Department in your state. These departments display the list on their web sites.

Medicaid is available to qualifying people all over the U.S., but they must meet certain resource and income limits, which vary by eligibility group.

The OBRA act (federal law) requires that pharmacists conduct prospective drug utilization reviews (DUR). Prospective DUR occurs before the prescription is dispensed to the patient. Prospective DUR encompasses more than one phase.

First, a review of the patient profile is mandated to watch for problems due to:
prescription duplication, drug/disease contraindication, drug/drug interactions, incorrect dosage or duration of use, drug/allergy contraindications, clinical abuse or misuse

Second, the OBRA act requires that pharmacists be responsible for patient counseling. As part of the prospective drug utilization review, the pharmacy must offer to counsel each Medicaid patient who receives a prescription, but the patient is not required to accept counseling.

If the patient accepts or requests counseling, then the pharmacist is required to provide it. The pharmacist is the only member of the pharmacy staff who is qualified to counsel a patient.





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2006