What Medicaid covers for the PureWick System

Medicaid does cover the PureWick System in most states, but coverage depends on your state's Medicaid program and whether your doctor writes a prescription for it as medical equipment. PureWick is a non-invasive external catheter system designed for people with urinary incontinence who cannot use traditional catheters or manage incontinence another way. Because it is classified as durable medical equipment (DME), your state Medicaid program may pay for it — but you will need a doctor's order, and the coverage rules vary by state.

The system itself includes a small external pouch that attaches to the skin and connects to a collection container. Medicaid typically covers the initial device and replacement supplies, though how often you can get new supplies and what you pay out of pocket depends on your specific state plan. Some states cover it fully; others require a copay or have limits on how many replacement kits you can receive per month.

Key Takeaways

  • Your doctor must write a prescription for PureWick as durable medical equipment before Medicaid will consider covering it.
  • Coverage exists in most states but the amount Medicaid pays and what you pay out of pocket varies by state program.
  • You will need to order through a Medicaid-approved DME supplier, not directly from the manufacturer.
  • Replacement supplies are usually covered, but the frequency and quantity allowed per month differs by state.
  • Contact your state Medicaid office or your DME supplier to confirm what your specific plan covers before ordering.

How to get a prescription from your doctor

Your doctor needs to document that you have urinary incontinence and that PureWick is medically necessary for you — meaning other options like absorbent pads, traditional catheters, or behavioral management have not worked or are not safe for you. The prescription should specify that you need the external catheter system and replacement supplies. Without this prescription, Medicaid will not pay.

When you see your doctor, bring information about your incontinence: how often it happens, what you have already tried, and why those options did not work. If your doctor is not familiar with PureWick, you can ask them to contact your state Medicaid program or a DME supplier for information about the medical criteria. Many doctors have prescribed it before and know the process, but some may need to research it first.

Finding a Medicaid-approved DME supplier

Once you have a prescription, you cannot order PureWick directly from the company. You must use a supplier that is enrolled in your state's Medicaid program as a durable medical equipment provider. Your doctor's office can often tell you which suppliers in your area are Medicaid-approved, or you can call your state Medicaid office and ask for a list of DME suppliers near you who carry PureWick.

When you contact the supplier, tell them you have Medicaid and ask them to verify your coverage before they send anything. They will check your state plan, confirm the prescription is on file, and tell you what your out-of-pocket cost will be. This step prevents surprises — some suppliers will bill Medicaid directly and you pay only your copay, while others may ask you to pay upfront and then submit to Medicaid yourself.

What varies by state

Medicaid is run by each state, so coverage rules differ. Some states cover PureWick with no copay; others charge a small copay per supply order. Some states limit you to one replacement kit per week; others allow two or three. A few states have not yet added PureWick to their DME list, though this is becoming less common as the product gains recognition.

Your state Medicaid program's website usually lists covered DME items, though the list can be hard to search. A faster way is to call your state Medicaid office directly and ask: "Does my plan cover the PureWick external catheter system?" Have your Medicaid number ready. You can also ask your DME supplier to check — they do this routinely and can tell you in minutes whether your state covers it and what the copay is.

Coverage for replacement supplies

Medicaid typically covers the replacement kits (the pouches and collection containers you use with the system), but the number you can receive per month varies. Some states allow four kits per month; others allow eight. Your DME supplier will know your state's limit and will not send more than Medicaid will pay for in a given month.

If you need more supplies than your state allows, you can pay out of pocket for the extra kits, or you can ask your doctor to document medical reasons why you need more frequent changes. Some states will increase the supply limit if your doctor writes that you have skin sensitivity or other conditions requiring more frequent changes. This requires a prior authorization request, which your DME supplier can submit on your behalf.

What to do if your state does not cover it

If your state Medicaid program does not cover PureWick, you have a few options. First, ask your doctor to submit a prior authorization request — a formal letter to Medicaid explaining why PureWick is medically necessary for you and why other options will not work. Some states approve coverage on a case-by-case basis even if it is not on the standard list.

If prior authorization is denied, you can file an appeal with your state Medicaid office. The appeal process varies by state, but you typically have 30 to 60 days to request a hearing. Your doctor's support is important here — ask them to write a letter explaining the medical need. You can also contact your state's Medicaid ombudsman, a free service that helps people understand their rights and navigate disputes with Medicaid.

If Medicaid will not cover it, PureWick offers a patient assistance program that may reduce the cost. You can also check whether you are covered under Medicare (if you are 65 or older or have certain disabilities), as Medicare has different coverage rules than Medicaid.

Frequently Asked Questions

Do I need prior authorization before ordering PureWick?

It depends on your state. Some states require your doctor or DME supplier to get prior authorization before sending the first order; others do not. Your DME supplier will know your state's rule and will handle the authorization request if needed. Always ask the supplier whether authorization is required before they place your order.

What if my doctor says I need PureWick but my state Medicaid says it is not covered?

Ask your doctor to submit a prior authorization request to your state Medicaid program, explaining the medical reasons you need it. If Medicaid denies the request, you can file an appeal within 30 to 60 days. Contact your state Medicaid office or your state's Medicaid ombudsman for help with the appeal process.

Can I use any DME supplier, or does it have to be a specific company?

You must use a supplier that is enrolled in your state Medicaid program. Different suppliers may be approved in different areas. Your doctor's office or your state Medicaid office can give you a list of approved suppliers near you. You can choose which one to use, but they must be Medicaid-enrolled.

Will I have to pay anything out of pocket?

That depends on your state plan. Some states cover PureWick with no copay; others charge a small copay per supply order. Your DME supplier can tell you your exact copay before they send anything. If you need more supplies than your state allows per month, you can pay out of pocket for the extras.

What if I am on both Medicaid and Medicare?

If you have both, Medicare is usually the primary payer. Contact Medicare first to see whether they cover PureWick under your plan. If Medicare does not cover it or covers only part of it, Medicaid may cover the rest. Your DME supplier can coordinate between both programs.