Xanax pills.
Medicaid is a state-administered program that provides health coverage to certain eligible disabled and low-income individuals. The federal and state government share funding for Medicaid. The exact coverage and eligibility guidelines vary among states. Xanax is a benzodiazepine medication that is used for treating anxiety disorders; it has a calming effect that can help prevent panic attacks and make anxiety more manageable. Xanax is typically covered under Medicaid programs, but coverage varies depending on state Medicaid plan guidelines.
Forms
Xanax is available in a generic form called alprazolam. Medicaid programs have a strong preference to use of generic forms of drugs, since generics must meet the same safety and effectiveness standards as brand name medications and are also considerably cheaper. Xanax XR is an extended-release form of alprazolam that is not available in a generic form. Brand name Xanax and Xanax XR are less likely to be covered under state Medicaid plans than the generic alprazolam.
Limits
Medicaid programs have quantity limits in place for maximum daily dosage, number of pills per month and number of medications simultaneously prescribed from the same class. In the case of Xanax, Medicaid typically will not cover more than 90 pills of Xanax per month regardless of the strength, unless an override request or prior authorization is submitted by the pharmacy or prescribing physician. Dosages exceeding 6mg per day typically require that a prior authorization be submitted. Xanax and another drug from the benzodiazepine class are being prescribed simultaneously; a prior authorization that states the reasons why both benzodiazepines are being prescribed is typically required. The prior authorization requires a statement from the prescribing physician regarding reasons why each benzodiazepine is being prescribed and is more likely to be approved if the benzodiazepines are being prescribed to treat separate medical conditions.
Prior Authorizations
A prior authorization may be required for coverage of Xanax under Medicaid, especially if the brand name version or Xanax XR is requested or in cases when the quantity limit is exceeded. Prior authorizations require a form to be submitted by the prescribing physician that states reasons why a certain medication is necessary for a patient. A common guideline is that preferred drugs must be prescribed first, and if the efficacy of the preferred drugs is low, then the non-preferred drug may be covered.
Type of Plan
States offer different types of Medicaid plans, some of which may not cover Xanax. Contact your local or state Medicaid office in order to inquire about different types of Medicaid plans and how the plans vary with coverage of Xanax.
Medicare & Medicaid
Individuals who have Medicare Part D prescription drug coverage and Medicaid must have all prescription billing requests sent to their Part D provider first. Xanax and other benzodiazepines are not covered under any Part D program, so the Part D provider will reject the claim. After the claim is rejected, the claim can be submitted to Medicaid for consideration for coverage under the Medicaid program. If the claim for Xanax is submitted only to Medicaid, Medicaid will deny the claim.
