Mississippi Medicaid provides health coverage to eligible low income residents, including children, pregnant women, people with disabilities, and adults in certain other categories. The pharmacy benefit, covering prescription drugs, is a core component of that coverage. Understanding how it works helps beneficiaries avoid unexpected costs and helps families navigate coverage effectively.
How Mississippi Medicaid Pharmacy Benefits Work
Mississippi Medicaid (administered by the Mississippi Division of Medicaid, or DOM) uses a pharmacy benefit structure that includes:
- A Preferred Drug List (PDL), the list of medications the program covers at standard cost sharing
- A Universal PDL that applies across all managed care plans
- A single Pharmacy Benefit Administrator (PBA), as of July 1, 2024, Mississippi Medicaid consolidated all pharmacy claims under a single PBA to standardize processing statewide
The Mississippi Division of Medicaid confirms that the pharmacy program "does not cover all drugs" and that "some require prior authorization" or have "limitations on age, dosage or maximum quantities."
The Preferred Drug List
The Preferred Drug List is the formulary, the catalog of drugs that Medicaid will cover. Drugs on the PDL are generally approved and will be dispensed with standard processing. Drugs not on the PDL may require prior authorization.
Magnolia Health Plan (a Mississippi Medicaid managed care plan) notes that the pharmacy program "does not cover all drugs, some require prior authorization, and some drugs have limitations on age, dosage or maximum quantities."
Practical guidance: If your prescriber writes a prescription that gets rejected at the pharmacy as "not covered" or "prior authorization required," the first step is calling your pharmacy. A pharmacist can:
- Verify whether the drug is on the PDL
- Identify therapeutically equivalent alternatives that ARE on the PDL (this is often faster than waiting for prior auth)
- Help navigate the prior authorization process if the drug is clinically necessary and no equivalent is available
Prior Authorization: What It Means
Prior authorization (PA) means that coverage approval from Medicaid must be obtained before the drug is dispensed. The prescriber typically initiates a PA request with the patient's clinical information. The process can take 24 to 72 hours for standard requests, or as little as a few hours for urgent cases.
If you arrive at the pharmacy and are told a medication requires prior authorization:
- Do not leave without asking the pharmacist whether a covered alternative exists
- The pharmacist can contact the prescriber's office to initiate or expedite the PA if no alternative is available
- If the medication is truly urgent, ask about emergency dispensing options
Blood Glucose Monitoring Products: A Recent Change
The Mississippi Division of Medicaid updated its PDL effective July 1, 2025: all OneTouch blood glucose test strips and meters moved to non preferred status. Medicaid instructs providers to "transition patients to one of the preferred brands."
This affects patients with diabetes using OneTouch products. If you have a OneTouch device and are on Mississippi Medicaid, talk to your pharmacist now, before you run out of strips, to identify which preferred brands your Medicaid plan will cover and, if needed, arrange for a new compatible meter.
What Medicaid Does NOT Cover
Mississippi Medicaid does not cover all prescriptions. Common exclusions include:
- Some over the counter medications (even if prescribed)
- Certain brand name drugs when a generic is available and not medically necessary
- Cosmetic treatments
- Some lifestyle medications (hair loss, weight loss in some categories)
- Medications outside the approved PDL without PA
When a drug is not covered, a pharmacist can often identify a covered therapeutic equivalent, a different drug in the same class that achieves similar results and is on the PDL.
Vaccines Under Mississippi Medicaid
Immunizations are a covered benefit under Mississippi Medicaid for all eligible populations. The Mississippi State Department of Health notes that childhood immunizations are free to those who qualify for the Vaccines for Children (VFC) program. Adult vaccines, flu, pneumonia, shingles, Tdap, are covered for adult Medicaid beneficiaries at participating pharmacies and health departments.
When to Talk to a Pharmacist
Call or come in if:
- A prescription was rejected at the pharmacy and you don't understand why
- You want to know if a medication your doctor prescribed is on the Medicaid PDL
- You use OneTouch glucose monitoring products and want to understand your options under the updated PDL
- You want to understand your options for medications that require prior authorization
- You are a caregiver managing prescriptions for a family member on Medicaid and need help navigating coverage
Fairview Pharmacy is familiar with Mississippi Medicaid coverage rules and can help you navigate your benefits to minimize disruptions to your care.
This article is for general information only and is not a substitute for personalized medical advice. Before starting or changing any medication, including over the counter products and supplements, talk with your pharmacist or physician about your specific situation.