State Medicaid Pharmacy Copay Requirements
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As of July 1, 2019
| Location | FFS Pharmacy Copay for Adults | Pharmacy Reimbursement Decreased by Copay Amount | Copay Requirements for Non-ACA Expansion Adults | Copay Requirements for ACA Expansion Adults | MCO Copays Differ from FFS Copays | If Yes, Description |
|---|---|---|---|---|---|---|
| United States | Yes: 37, No: 13, NR: 1 | Yes: 33, No: 4, No FFS Copays: 13, NR: 1 | Yes: 11, No: 15, No FFS Copays: 10, N/A: 14 , NR: 1 | |||
| Alabama | Yes | Yes | $0-$3.90 based on drug cost | Non-expansion state | N/A | |
| Alaska | Yes | Yes | $0.50 copay for drugs less than $50, $3.50 copay for drugs $50 or greater | $0.50 copay for drugs less than $50, $3.50 copay for drugs $50 or greater | N/A | |
| Arizona | No | No FFS copays | No FFS copays | |||
| Arkansas | Yes | Yes | Copay based on sliding scale, depending on drug cost | No copay | Yes | No MCO copay |
| California | No | No FFS copays | No FFS copays | |||
| Colorado | Yes | Yes | $3.00 copay with exceptions | $3.00 copay with exceptions | No | |
| Connecticut | No | No FFS copays | N/A | |||
| Delaware | Yes | Yes | $0.50-$3.00 copay based on drug cost, with a 30-day maximum of $15.00 | $0.50-$3.00 copay based on drug cost, with a 30-day maximum of $15.00 | No | |
| District of Columbia | Yes | Yes | $1.00 copay, with exceptions (no copay for LTC residents, pregnant women, smoking cessation and family planning drugs) | $1.00 copay, with exceptions (no copay for LTC residents, pregnant women, smoking cessation and family planning drugs) | Yes | No MCO copay |
| Florida | No | No FFS copays | Non-expansion state | No FFS copays | ||
| Georgia | Yes | Yes | A $0.50 copay for preferred products and up to a $3.00 copay for non-preferred products | Non-expansion state | No | |
| Hawaii | No | No FFS copays | No FFS copays | |||
| Idaho | No | No FFS copays | Non-expansion state | No FFS copays | ||
| Illinois | Yes | Yes | $2.00 copay for generic drugs, $3.90 copay for brand drugs | $2.00 copay for generic drugs, $3.90 copay for brand drugs | Yes | MCOs may set their own copays, no higher than FFS copays |
| Indiana | Yes | Yes | $3.00 copay for brand drugs, $3.00 copay for generic drugs | $4.00 copay for preferred drugs, $8.00 copay for non-preferred drugs | No | |
| Iowa | Yes | Yes | $1.00 copay for all drugs | No copay | Yes | No MCO copay |
| Kansas | Yes | Yes | $3.00 copay per prescription per date filled | Non-expansion state | Yes | No MCO copay |
| Kentucky | Yes | No | $1.00 copay for preferred and non-preferred generic drugs, $1.00 copay for brand drugs preferred on formulary over generic equivalents, $4.00 copay for brand drugs | $1.00 copay for preferred and non-preferred generic drugs, $1.00 copay for brand drugs preferred on formulary over generic equivalents, $4.00 copay for brand drugs | No | |
| Louisiana | Yes | Yes | $0.50 copay for drugs that cost $10.00 or less, $1.00 copay for drugs that cost $10.01 to $25.00, $2.00 copay for drugs that cost $25.01 to $50.00, $3.00 copay for drugs that cost $50.01 or more | $0.50 copay for drugs that cost $10.00 or less, $1.00 copay for drugs that cost $10.01 to $25.00, $2.00 copay for drugs that cost $25.01 to $50.00, $3.00 copay for drugs that cost $50.01 or more | No | |
| Maine | Yes | No | $3.00 copay per prescription, except for tobacco cessation products, total copays not to exceed $30.00 per member per month | $3.00 copay per prescription, except for tobacco cessation products, total copays not to exceed $30.00 per member per month | N/A | |
| Maryland | Yes | Yes | $1.00 copay for generic drugs and preferred brand drugs, $3.00 copay for other brand drugs | $1.00 copay for generic drugs and preferred brand drugs, $3.00 copay for other brand drugs | Yes | MCO copays may vary, five MCOs do not have copays |
| Massachusetts | Yes | Yes | $3.65 copay for all drugs with exceptions, $1.00 copay for generic anti-hypertensives, diabetes, and hypercholesterolemia drugs | $3.65 copay for all drugs with exceptions, $1.00 copay for generic anti-hypertensives, diabetes, and hypercholesterolemia drugs | No | |
| Michigan | Yes | Yes | $1.00 copay for generic and preferred drugs, $3.00 copay for brand and non-preferred drugs | $4.00 copay for generic and preferred drugs, $8.00 copay for brand and non-preferred drugs | Yes | No MCO copay, except for the Healthy Michigan Plan, which employs a cost-sharing responsibility process using the MI Health Account |
| Minnesota | Yes | Yes | $3.00 copay for brand drugs, $1.00 copay for generic drugs | $3.00 copay for brand drugs, $1.00 copay for generic drugs | No | |
| Mississippi | Yes | Yes | $3.00 copay except for certain beneficiary categories such as infants, children, pregnancy, family planning, LTC residents | Non-expansion state | Yes | No MCO copay |
| Missouri | Yes | No | Copays based on ingredient cost for each prescription, copay of $0.50 for drugs $0-$10.00, copay of $1.00 for drugs $10.01-$25.00, copay of $2.00 for drugs $25.01 and higher | Non-expansion state | N/A | |
| Montana | Yes | Yes | $4.00 copay for preferred brand drugs, $8.00 copay for non-preferred brand drugs, no copays for generic drugs and select therapeutic drug classes | $4.00 copay for preferred brand drugs, $8.00 copay for non-preferred brand drugs, no copays for generic drugs and select therapeutic drug classes | N/A | |
| Nebraska | Yes | Yes | $2.00 copay for generic drugs, $3.00 copay for brand drugs except for family planning medications, children and pregnant women | Non-expansion state | Yes | MCOs waive some copays |
| Nevada | No | No FFS copays | No FFS copays | |||
| New Hampshire | Yes | Yes | $1.00 copay | $1.00 copay | No | |
| New Jersey | No | No FFS copays | No FFS copays | |||
| New Mexico | No | No FFS copays | No | |||
| New York | Yes | Yes | $1.00 copay for preferred brand drugs, generic drugs, and brand drugs costing less than generic equivalents, $3.00 copay for non-preferred brand drugs, $0.50 copay for over-the-counter drugs | $1.00 copay for preferred brand drugs, generic drugs, and brand drugs costing less than generic equivalents, $3.00 copay for non-preferred brand drugs, $0.50 copay for over-the-counter drugs | No | |
| North Carolina | Yes | Yes | $3.00 copay per prescription | Non-expansion state | N/A | |
| North Dakota | Yes | Yes | $3.00 copay for brand drugs, no copay for generic drugs | $3.00 copay for brand drugs, no copay for generic drugs | No | |
| Ohio | Yes | No | $3.00 copay for drugs that require prior authorization, $2.00 copay for selected brand drugs | $3.00 copay for drugs that require prior authorization, $2.00 copay for selected brand drugs | Yes | No MCO copay |
| Oklahoma | Yes | Yes | $4.00 copay | Non-expansion state | N/A | |
| Oregon | No | No FFS copays | No | |||
| Pennsylvania | Yes | Yes | $3.00 copay for brand drugs, $1.00 copay for generic drugs, no copays for many drug classes and beneficiaries who are under 21 or pregnant | $3.00 copay for brand drugs, $1.00 copay for generic drugs, no copays for many drug classes and beneficiaries who are under 21 or pregnant | No | |
| Rhode Island | No | No FFS copays | No FFS copays | |||
| South Carolina | Yes | Yes | $3.40 copay | Non-expansion state | No | |
| South Dakota | Yes | Yes | $3.30 copay for brand drugs, $1.00 copay for generic drugs | Non-expansion state | N/A | |
| Tennessee | Yes | Yes | $1.50 copay for generic drugs and preferred brand drugs, $3.00 copay for brand drugs | Non-expansion state | N/A | |
| Texas | No | No FFS copays | Non-expansion state | No FFS copays | ||
| Utah | NR | NR | NR | |||
| Vermont | Yes | Yes | $1.00 copay for drugs with a Medicaid reimbursement rate of less than $30.00, $2.00 copay for drugs with a Medicaid reimbursement rate of $30.00 to $50.00, $3.00 copay for drugs with a Medicaid reimbursement rate of $50.00 or more | $1.00 copay for drugs with a Medicaid reimbursement rate of less than $30.00, $2.00 copay for drugs with a Medicaid reimbursement rate of $30.00 to $50.00, $3.00 copay for drugs with a Medicaid reimbursement rate of $50.00 or more | N/A | |
| Virginia | Yes | Yes | $1.00 copay for generic drugs, $3.00 copay for brand drugs | $1.00 copay for generic drugs, $3.00 copay for brand drugs | Yes | No MCO copay |
| Washington | No | No FFS copays | No FFS copays | |||
| West Virginia | Yes | Yes | $0.00 to $3.00 copay depending on the cost of the drug | $0.00 to $3.00 copay depending on the cost of the drug | N/A | |
| Wisconsin | Yes | Yes | $3.00 copay for brand drugs, $1.00 copay for generic drugs and compounded products, $0.50 copay for over-the-counter drugs and diabetic supplies, up to a maximum copay of $12.00 per member per provider per calendar month | Non-expansion state | N/A | |
| Wyoming | Yes | Yes | $0.65 copay for generic drugs, $3.65 copay for brand drugs | Non-expansion state | N/A |