Medicaid provides health coverage for millions of Americans, including many with substantial health needs who rely on Medicaid drug coverage both for treating acute problems and for managing ongoing chronic or disabling conditions. Though optional, all states provide pharmacy benefit coverage and administer the benefit in different ways within federal guidelines. This Data Collection provides information related to the administration and delivery of Medicaid pharmacy benefits based on a survey of states conducted by Kaiser Family Foundation and Health Management Associates between June and December 2019.
Create a Custom State Report
Use this page to start a custom report compiling data related to Medicaid pharmacy policy for a single state or multiple states.
Step 1: Choose from the selection of State Health Facts indicators below by clicking the “+” button next to indicators in the “Add to Custom State Report” column.
Step 2: Once you’ve selected the indicators to include, click “Select States” at the bottom of the page to choose the states to be included in the report.
Or, view individual indicators included in this collection by clicking the icon next to indicators in the “View Indicator” column.
Medicaid Pharmacy Benefit Administration
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Use of Pharmacy Vendors and PBMs for Medicaid Fee-for-Service Benefit
View details about Use of Pharmacy Vendors and PBMs for Medicaid Fee-for-Service Benefit
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Services Provided by Pharmacy Vendors or PBMs in Medicaid Fee-for-Service Benefit
View details about Services Provided by Pharmacy Vendors or PBMs in Medicaid Fee-for-Service Benefit
View Indicator for Services Provided by Pharmacy Vendors or PBMs in Medicaid Fee-for-Service Benefit
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Inclusion of Pharmacy Benefits in Medicaid MCO Contracts
View details about Inclusion of Pharmacy Benefits in Medicaid MCO Contracts
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Prohibition of Spread Pricing in Medicaid MCO Contracts
View details about Prohibition of Spread Pricing in Medicaid MCO Contracts
Medicaid Drug Utilization Review
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Conflict of Interest Policies in Medicaid Pharmacy Review
View details about Conflict of Interest Policies in Medicaid Pharmacy Review
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Uniform Clinical Protocols for Medicaid MCOs
View details about Uniform Clinical Protocols for Medicaid MCOs
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State Medicaid Drug Review Responsibilities
View details about State Medicaid Drug Review Responsibilities
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Use of Comparative Effectiveness Reviews in Medicaid Drug Reviews
View details about Use of Comparative Effectiveness Reviews in Medicaid Drug Reviews
Medicaid Pharmacy Payment and Purchasing Policies
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State Medicaid Pharmacy Copay Requirements
View details about State Medicaid Pharmacy Copay Requirements
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State Medicaid Pharmacy Supplemental Rebate Agreements
View details about State Medicaid Pharmacy Supplemental Rebate Agreements
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State Medicaid MCO Supplemental Pharmacy Rebates
View details about State Medicaid MCO Supplemental Pharmacy Rebates
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Value-Based Arrangements in Medicaid Pharmacy Programs
View details about Value-Based Arrangements in Medicaid Pharmacy Programs
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State Medicaid Participation in Interstate Purchasing Pools for Prescription Drugs
View details about State Medicaid Participation in Interstate Purchasing Pools for Prescription Drugs
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State Medicaid MCO Pharmacy Minimum Dispensing Fees
View details about State Medicaid MCO Pharmacy Minimum Dispensing Fees
Medicaid Pharmacy Utilization Control
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State Medicaid Preferred Drug Lists
View details about State Medicaid Preferred Drug Lists
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State Statutory Limits on Medicaid Pharmacy Utilization Controls
View details about State Statutory Limits on Medicaid Pharmacy Utilization Controls
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State Medicaid Prescription Limits
View details about State Medicaid Prescription Limits
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Differences in Prior Authorization Rules in State Medicaid MCO and FFS Pharmacy Benefit
View details about Differences in Prior Authorization Rules in State Medicaid MCO and FFS Pharmacy Benefit
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State Policies on Generic Drug Utilization in Medicaid
View details about State Policies on Generic Drug Utilization in Medicaid
The Medicaid Pharmacy Benefit and 340B
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Inclusion of 340B Drugs in State Medicaid Pharmacy Benefit
View details about Inclusion of 340B Drugs in State Medicaid Pharmacy Benefit
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State Medicaid Pharmacy Payment to 340B Covered Entities
View details about State Medicaid Pharmacy Payment to 340B Covered Entities
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State Medicaid Requirements for 340B Contract Pharmacies
View details about State Medicaid Requirements for 340B Contract Pharmacies
About this Data Collection
Medicaid provides health coverage for millions of Americans, including many with substantial health needs who rely on Medicaid drug coverage both for treating acute problems and for managing ongoing chronic or disabling conditions. Though optional, all states provide pharmacy benefit coverage and administer the benefit in different ways within federal guidelines.
This Data Collection provides information related to Medicaid pharmacy benefits based on a survey of 50 states and DC conducted by Kaiser Family Foundation and Health Management Associates between June and December 2019. Utah did not respond. This data reports Medicaid pharmacy policies in place or implemented in FY 2019, policy changes implemented at the beginning of FY 2020, and policy changes for which a definite decision has been made to implement in FY 2020 (which began for most states on July 1, 2019).
For updated information on changes to Medicaid pharmacy benefits related to COVID-19, please see Medicaid Emergency Authority Tracker: Approved State Actions to Address COVID-19