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Table 1 Prescription cap policies by state, 2001-2010

From: Medicaid prescription limits: policy trends and comparative impact on utilization

State

Cap policy type

Policy start date

Policy end date

Overall prescription limit

Branded prescription limit

Number of drugs (maximum number of exceptions) per member per month unless otherwise noted

Alabama

Brand

7/1/2004

12/31/2007

-

4 (10)

Alabama

Brand

1/1/2008

After 1/1/2011

-

5 (10)

Arkansas

Overall

Before 12/31/2000

After 1/1/2011

3 (3)

-

California

Overall

Before 12/31/2000

After 1/1/2011

6

-

Colorado

Overall

4/1/2003

6/2/2003

8

-

Delaware

Overall

1/1/2005

5/18/2009

15

-

Delaware

Overall

5/19/2009

After 1/1/2011

13

-

Florida

Brand

Before 12/31/2000

6/30/2005

-

4

Georgia

Overall

Before 12/31/2000

Oct-Dec 07e

5f

 

Illinois

Brand

10/1/2005

After 1/1/2011

-

3

Kansas

Brand

4/1/2003

After 1/1/2011

-

5

Kentucky

Brand

4/19/2005

2/28/2006

-

3

Kentucky

Both

3/1/2006

After 1/1/2011

4

3

Louisiana

Overall

3/3/2003

4/30/2009

8

-

Louisiana

Overall

5/1/2009

11/30/2010

5

-

Louisiana

Overall

12/1/2010

After 1/1/2011

4

-

Mainea

Brand

11/2/2004c

6/30/2007

-

5

Maine

Brand

7/1/2007

After 1/1/2011

-

4

Mississippi

Overall

Before 12/31/2000

5/30/2002

10

-

Mississippi

Overall

6/1/2002

6/30/2005

5 (1)

-

Mississippi

Both

7/1/2005

After 1/1/2011

5

2

New York

Overall

Before 12/31/2000

8/31/2010

40/43 annuallyg

-

New York

Overall

9/1/2010d

After 1/1/2011

Clinicalh

-

North Carolina

Overall

Before 12/31/2000

5/30/2006

6

-

North Carolina

Overall

6/1/2006

After 1/1/2011

8 (3)

-

Oklahoma

Overall

Before 12/31/2000

12/31/2003

3

-

Oklahoma

Both

1/1/2004

12/31/2009

6

3

Oklahoma

Both

1/1/2010

After 1/1/2011

6

2

Oregon

Overall

2/1/2004

After 1/1/2011

15i

-

Pennsylvaniaa

Overall

Before 12/31/2000

After 1/1/2011

6

-

South Carolina

Overall

Before 12/31/2000

7/19/2010

4 (6)

-

South Carolina

Overall

7/20/2010

After 1/1/2011

4 (4)

-

Tennessee

Both

8/1/2005

After 1/1/2011

5

2

Texas

Overall

Before 12/31/2000

After 1/1/2011

3

-

Utahb

Overall

1/1/2002

Between 2005-2010e

7

-

Utaha,b

Overall

7/1/2002

After 1/1/2011

7

-

Washington

Brand

2/1/2002

6/30/2007

-

4

West Virginia

Overall

Before 12/31/2000

7/14/2002

10

-

West Virginiaa

Overall

March 2007c

After 1/1/2011

4

-

  1. a Policy affecting limited groups of recipients (see Text, Additional file 1 Digital Content 1, results)
  2. b Utah started a new program called non-traditional Medicaid (NTM) on this date with the cap in effect. The cap for traditional Medicaid was removed between 2005 and January 2010 but remained in place for NTM (see Text, Additional file 1 Digital Content 1, results)
  3. c Policy implemented gradually on this date
  4. d Policy gradually implemented starting in the second half of 2008 but was not enforced until 9/1/2010
  5. e The exact date of policy change was unclear based on available information (see Table 2, Additional file 1 Digital Content 2)
  6. f Recipients below age 21 limited to 6 prescriptions per month
  7. g Recipients <21 or ≥65, certified blind or disabled, or single caretaker of a child under 18 are limited to 40 prescriptions annually; all other recipients limited to 43 prescription annually (see Text, Additional file 1 Digital Content 1, results)
  8. h Annual prescription limits based on patient clinical information (see Text, Additional file 1 Digital Content 1, results)
  9. i May impose limitations on clients with prescriptions for more than 15 unique drugs in a 6 month period
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