Medicaid Pharmacy Policy & Administration

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.

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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.

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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.

indicators in this collection

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