Resources provided on this page include an in-depth look into each state’s coverage and reimbursement methodology as provided in the state’s Medicaid plan. We also provide a list of State Pharmaceutical Assistance Programs (SPAP) that currently meet our criteria for exemption from the manufacturers’ calculations of best price. This state prescription drug resource page includes the following contents related to the Medicaid Pharmacy Program:
- State Medicaid Reimbursement Information
- Qualified State Pharmaceutical Assistance Programs
State Medicaid Reimbursement Information
The Medicaid reimbursement chart outlines the methodologies and professional dispensing fee amounts utilized by states and includes each state’s drug ingredient cost, dispensing fee and maximum allowable cost (MAC) and reimbursement methodologies as provided in the state’s Medicaid plan. Pharmacy payment requirements are outlined in Federal regulations at 42 CFR 447 Subpart F. The Code of Federal Regulations specifically covers payment requirements for estimated acquisition cost and reasonable dispensing fees. Co-payment amounts are addressed at 42 CFR 447.54. Information will be updated and posted on the web quarterly with the data provided for in the CMS approved state plans. We update the chart quarterly and archive the previous four quarters.
Medicaid Prescription Reimbursement Information by State - Quarter Ending December 2022
Qualified State Pharmaceutical Assistance Programs
The Medicaid statute allows manufacturers participating in the Medicaid Drug Rebate Program to exclude prices to SPAPs from their Medicaid best price calculations. CMS has compiled a list of programs that meet the criteria to be considered SPAPs called Medicaid SPAP Best Price List (PDF, 95.82 KB). For the purposes of determining whether a SPAP is excluded from the Medicaid best price, manufacturers should refer to this list. Please note that this list only includes states that submitted a description of programs to CMS for review based on the established criteria in CMS' Manufacturer Release No. 68 (PDF, 141.03 KB) (April 1, 2005). The qualification of state-only programs as SPAPs is based on the information provided by the state and may be subject to further review if changes occur within the program.
Questions regarding the topics on this page? Email RxDrugPolicy@cms.hhs.gov.
Disclaimer: Please note that the information provided on this web page does not bind or obligate the Centers for Medicare and Medicaid Services (CMS). The statements included on this web page are intended to provide information on State Prescription Drug Resources and do not in any way revise or modify the requirements set forth in Section 1927 of the Act, the national drug rebate agreement (NDRA), subsequent program releases, or regulations.
Page last updated on January 26, 2023