Under ACA subsidy rules, most Medicaid recipients are not required to make RX copays if they declare they cannot afford them, even 3 dollar copays.  Opiates should be the exception.  I suggest a $25 per week copay that comes straight from their government check(s).  I know, I know, the liberals will say that 99.999% of these folks are virtuous and honorable and all of them are in excruciating pain and that a life long supply of high dose opiates is the only thing that works.