Medicaid Formulary: What Drugs Are Covered and How to Get Them

When you're on Medicaid, a U.S. government health program for low-income individuals and families. Also known as state-funded public insurance, it helps millions pay for medical care—including prescriptions. But not every drug is covered. That’s where the Medicaid formulary, a list of approved medications that Medicaid will pay for. Also known as preferred drug list, it determines which pills, injections, and inhalers you can get without extra steps or denials.

The Medicaid formulary isn’t the same everywhere. Each state runs its own program, so a drug covered in California might need prior authorization in Texas or be completely excluded in Florida. These lists are built around cost, safety, and clinical effectiveness. They usually include generics first, then brand-name drugs only if there’s no cheaper alternative. Many formularies require step therapy—you have to try a cheaper drug before they’ll pay for the one your doctor originally prescribed. Some drugs, like weight-loss pills or erectile dysfunction meds, are almost never covered unless there’s a rare medical exception.

What you’ll find in the posts below are real, practical guides that connect directly to how Medicaid formularies affect everyday care. You’ll read about how generic medications, lower-cost versions of brand-name drugs that work the same way. Also known as generic drugs, they’re often the first choice on Medicaid lists can save you money without risking your health. Others show how acid-reducing medications, drugs like PPIs that lower stomach acid but can interfere with other pills. Also known as proton pump inhibitors, they’re frequently restricted due to overuse interact with other prescriptions, making them tricky to approve. You’ll also see how drug-resistant bacteria, infections that no longer respond to common antibiotics. Also known as antimicrobial resistance, they’ve led to tighter controls on antibiotic prescriptions are changing what drugs Medicaid will cover. These aren’t theoretical discussions—they’re real stories from people who’ve had to fight for their meds, switch treatments, or learn how to appeal a denial.

If you’re on Medicaid and struggling to get a prescription filled, you’re not alone. The system is confusing, rules change often, and pharmacies don’t always explain your options. Below, you’ll find clear, no-fluff advice on how to check your state’s formulary, what to do when a drug is denied, how to ask for exceptions, and which medications are most likely to be approved—or blocked. This isn’t about guessing. It’s about knowing exactly what’s covered, why, and how to make sure you get what you need.