1 Montana $12.83 $17.52 +$0.83 +$0.00 (+0.0%)2025-07-01 to 2026-09-30; in effect since July 1, 2025 (up from $11.41) July 1, 2025 Montana SPA 25-0016
Standard fee on each dated source $13.33 $10.80 2020-12-31: $11.30, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $11.41, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2025-07-01: $12.83, Montana SPA 25-0016 (effective July 1 2025) 2025-07 2026-09-30: $12.83, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $11.30, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $11.41, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) July 1, 2025: $12.83, Montana SPA 25-0016 (effective July 1 2025) September 30, 2026: $12.83, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $12.83 on July 1, 2025 (Montana SPA 25-0016 (effective July 1 2025) ) to $12.83 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ). The fee was in effect since July 1, 2025 (up from $11.41).
Standard rate 70,000 or more prescriptions a year
Tiered or special rates $15.17 40,000 to 69,999 prescriptions a year (source ) $17.52 Fewer than 40,000 prescriptions a year (source ) Ingredient cost basis Lowest of: AAC, submitted ingredient cost, WAC, FUL (CMS file p. 16; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026Montana SPA 25-0016 (effective July 1 2025) , checked November 4, 2026
2 North Dakota $12.46 $12.46 +$0.46 +$0.00 (+0.0%)2025-01-01 to 2026-09-30 no change North Dakota SPA 25-0007
Standard fee on each dated source $13.46 $11.46 2019-07-01: $12.46, North Dakota SPA 19-0004 (effective July 1 2019) 2019-07 2020-12-31: $12.46, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $12.46, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2025-01-01: $12.46, North Dakota SPA 25-0007 (effective January 1 2025) 2025-01 2026-09-30: $12.46, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 July 1, 2019: $12.46, North Dakota SPA 19-0004 (effective July 1 2019) December 31, 2020: $12.46, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $12.46, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) January 1, 2025: $12.46, North Dakota SPA 25-0007 (effective January 1 2025) September 30, 2026: $12.46, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $12.46 on January 1, 2025 (North Dakota SPA 25-0007 (effective January 1 2025) ) to $12.46 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate Professional dispensing fee
Tiered or special rates $0.15 Pill splitting, added per pill (source ) Ingredient cost basis Lowest of: NADAC, WAC, MAC, U&C (CMS file p. 20; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026North Dakota SPA 19-0004 (effective July 1 2019) , checked November 4, 2026North Dakota SPA 25-0007 (effective January 1 2025) , checked November 4, 2026
3 Missouri $12.22 $12.22 +$0.22 +$0.00 (+0.0%)2021-02-01 to 2026-09-30; in effect since February 1, 2021 (up from $4.09) February 1, 2021 Missouri SPA 21-0008
Standard fee on each dated source $12.72 $3.59 2020-12-31: $4.09, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2021-02-01: $12.22, Missouri SPA 21-0008 (effective February 1 2021) 2021-02 2022-09-30: $4.09, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) (a state source supersedes it) 2022-09 2026-09-30: $12.22, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $4.09, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 February 1, 2021: $12.22, Missouri SPA 21-0008 (effective February 1 2021) September 30, 2022: $4.09, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ; a state source supersedes this chart value, so it is grey and off the line September 30, 2026: $12.22, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $12.22 on February 1, 2021 (Missouri SPA 21-0008 (effective February 1 2021) ) to $12.22 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ). The fee was in effect since February 1, 2021 (up from $4.09).
Standard rate In-state pharmacy, before the reimbursement allowance adjustment
Tiered or special rates $8.85 Out-of-state pharmacy (source ) $0.50 Long-term care pharmacies, added to the fee (source ) Ingredient cost basis NADAC; if none, state MAC; if neither, WAC; or U&C if lower (CMS file p. 15; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026Missouri SPA 21-0008 (effective February 1 2021) , checked November 4, 2026
4 Maine $11.89 $11.89 -$0.11 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 no change CMS file, September 2026, p. 10
Standard fee on each dated source $12.89 $10.89 2020-12-31: $11.89, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $11.89, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $11.89, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $11.89, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $11.89, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $11.89, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $11.89 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $11.89 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate Professional dispensing fee
Tiered or special rates Ingredient cost basis Generics, lowest of: NADAC, FUL, WAC, state MAC, submitted ingredient cost, U&C, GAD, AWP minus 16.67% (CMS file p. 10; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026
5 Louisiana $11.81 $11.81 -$0.19 +$0.00 (+0.0%)2023-10-01 to 2026-09-30; in effect since October 1, 2023 (up from $10.99) October 1, 2023 Louisiana SPA 23-0024
Standard fee on each dated source $12.31 $10.49 2020-12-31: $10.99, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $10.99, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2023-10-01: $11.81, Louisiana SPA 23-0024 (effective October 1 2023) 2023-10 2026-09-30: $11.81, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $10.99, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $10.99, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) October 1, 2023: $11.81, Louisiana SPA 23-0024 (effective October 1 2023) September 30, 2026: $11.81, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $11.81 on October 1, 2023 (Louisiana SPA 23-0024 (effective October 1 2023) ) to $11.81 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ). The fee was in effect since October 1, 2023 (up from $10.99).
Standard rate Professional dispensing fee
Tiered or special rates Ingredient cost basis Generics, lowest of: NADAC, WAC, FUL, U&C (CMS file p. 9; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026Louisiana SPA 23-0024 (effective October 1 2023) , checked November 4, 2026
6 Alaska $11.80 $11.80 -$0.20 +$0.00 (+0.0%)2025-07-01 to 2026-09-30; in effect since July 1, 2025 (down from $13.36) July 1, 2025 Alaska SPA 25-0006
Standard fee on each dated source $13.86 $11.30 2020-12-31: $13.36, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $13.36, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2025-07-01: $11.80, Alaska SPA 25-0006 (effective July 1 2025) 2025-07 2026-09-30: $11.80, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $13.36, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $13.36, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) July 1, 2025: $11.80, Alaska SPA 25-0006 (effective July 1 2025) September 30, 2026: $11.80, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $11.80 on July 1, 2025 (Alaska SPA 25-0006 (effective July 1 2025) ) to $11.80 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ). The fee was in effect since July 1, 2025 (down from $13.36).
Standard rate On the road system, non-tribal pharmacy
Tiered or special rates $22.17 Off the road system, non-tribal pharmacy (source ) $26.81 Tribal health pharmacy (source ) $10.76 Out-of-state pharmacy (source ) $16.58 Mediset pharmacy (source ) Ingredient cost basis Lowest of: amount billed, WAC plus 1%, SMAC (set at NADAC), FUL (in-state pharmacies) (CMS file p. 1; source )
Sources Alaska SPA 25-0006 (effective July 1 2025) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026
7 Utah $11.57 $11.57 -$0.43 +$0.00 (+0.0%)2024-07-15 to 2026-09-30; in effect since July 15, 2024 (up from $9.99) July 15, 2024 Utah SPA 24-0017
Standard fee on each dated source $12.07 $9.49 2020-12-31: $9.99, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $9.99, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2024-07-15: $11.57, Utah SPA 24-0017 (effective July 15 2024) 2024-07 2026-09-30: $11.57, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $9.99, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $9.99, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) July 15, 2024: $11.57, Utah SPA 24-0017 (effective July 15 2024) September 30, 2026: $11.57, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $11.57 on July 15, 2024 (Utah SPA 24-0017 (effective July 15 2024) ) to $11.57 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ). The fee was in effect since July 15, 2024 (up from $9.99).
Standard rate All prescriptions except hemophilia clotting factor
Tiered or special rates $97.53 Hemophilia clotting factor (source ) Ingredient cost basis Lowest of: WAC, FUL, Utah MAC (NADAC), submitted ingredient cost (CMS file p. 27; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026Utah SPA 24-0017 (effective July 15 2024) , checked November 4, 2026
8 Minnesota $11.55 $11.55 -$0.45 +$1.07 (+10.2%)2022-09-30 to 2024-10-01 October 1, 2024 Minnesota SPA 24-0034
Standard fee on each dated source $12.05 $9.98 2020-12-31: $10.48, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $10.48, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2024-10-01: $11.55, Minnesota SPA 24-0034 (effective October 1 2024) 2024-10 2026-09-30: $10.77, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 (a state source supersedes it) 2026-09 December 31, 2020: $10.48, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $10.48, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) October 1, 2024: $11.55, Minnesota SPA 24-0034 (effective October 1 2024) September 30, 2026: $10.77, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ; a state source supersedes this chart value, so it is grey and off the line Change since prior source +$1.07 (+10.2%): $10.48 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $11.55 on October 1, 2024 (Minnesota SPA 24-0034 (effective October 1 2024) ).
Standard rate Professional dispensing fee
Tiered or special rates $3.65 Prescribed OTC drugs that are not covered outpatient drugs (source ) Ingredient cost basis Lowest of: NADAC, state MAC, U&C; if neither NADAC nor MAC, WAC minus 2% (CMS file p. 14; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026Minnesota SPA 24-0034 (effective October 1 2024) , checked November 4, 2026
9 Idaho $11.51 $15.11 -$0.49 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 no change CMS file, September 2026, p. 6
Standard fee on each dated source $12.51 $10.51 2020-12-31: $11.51, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $11.51, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $11.51, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $11.51, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $11.51, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $11.51, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $11.51 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $11.51 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate 70,000 or more claims a year
Tiered or special rates $12.35 40,000 to 69,999 claims a year (source ) $15.11 Fewer than 40,000 claims a year (source ) Ingredient cost basis AAC; if no AAC, WAC (CMS file p. 6; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026
10 Mississippi $11.29 $11.29 -$0.71 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 no change CMS file, September 2026, p. 14
Standard fee on each dated source $12.29 $10.29 2020-12-31: $11.29, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $11.29, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $11.29, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $11.29, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $11.29, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $11.29, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $11.29 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $11.29 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate Professional dispensing fee
Tiered or special rates $61.14 Specialty drugs dispensed mainly by mail (source ) Ingredient cost basis Lowest of: NADAC (if none, WAC plus 0%), a rate set by the state's rate-setting vendor, U&C (CMS file p. 14; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026
11 District of Columbia $11.15 $11.15 -$0.85 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 no change CMS file, September 2026, p. 5
Standard fee on each dated source $12.15 $10.15 2020-12-31: $11.15, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $11.15, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $11.15, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $11.15, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $11.15, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $11.15, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $11.15 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $11.15 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate Professional dispensing fee
Tiered or special rates Ingredient cost basis Multiple source drugs, lowest of: FUL, NADAC, WAC, U&C, District MAC (CMS file p. 5; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026
12 Vermont $11.13 $11.13 -$0.87 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 no change Vermont SPA 17-0005
Standard fee on each dated source $12.13 $10.13 2017-04-01: $11.13, Vermont SPA 17-0005 (effective April 1 2017) 2017-04 2020-12-31: $11.13, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $11.13, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $11.13, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 April 1, 2017: $11.13, Vermont SPA 17-0005 (effective April 1 2017) December 31, 2020: $11.13, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $11.13, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $11.13, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $11.13 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $11.13 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate Retail community, institutional or long-term care pharmacy
Tiered or special rates $17.03 Specialty drugs (source ) Ingredient cost basis Lowest of: NADAC, WAC plus 0%, SMAC, FUL, AWP minus 19% (each plus the fee), submitted cost plus fee, U&C, gross amount due (CMS file p. 28; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026Vermont SPA 17-0005 (effective April 1 2017) , checked November 4, 2026
13 New Jersey $10.92 $10.92 -$1.08 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 no change New Jersey SPA 17-0002
Standard fee on each dated source $11.92 $9.92 2017-04-01: $10.92, New Jersey SPA 17-0002 (effective April 1 2017) 2017-04 2020-12-31: $10.92, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $10.92, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $10.92, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 April 1, 2017: $10.92, New Jersey SPA 17-0002 (effective April 1 2017) December 31, 2020: $10.92, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $10.92, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $10.92, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $10.92 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $10.92 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate Professional dispensing fee
Tiered or special rates Ingredient cost basis NADAC, WAC minus 2%, or SWP minus 19% (CMS file p. 17; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026New Jersey SPA 17-0002 (effective April 1 2017) , checked November 4, 2026
14 Oklahoma $10.87 $10.87 -$1.13 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 no change CMS file, September 2026, p. 21
Standard fee on each dated source $11.87 $9.87 2020-12-31: $10.87, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $10.87, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $10.87, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $10.87, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $10.87, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $10.87, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $10.87 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $10.87 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate Professional dispensing fee
Tiered or special rates Ingredient cost basis Generics, lowest of: state MAC, NADAC, WAC (CMS file p. 21; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026
15 Hawaii $10.76 $10.76 -$1.24 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 no change CMS file, September 2026, p. 6
Standard fee on each dated source $11.76 $9.76 2020-12-31: $10.76, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $10.76, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $10.76, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $10.76, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $10.76, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $10.76, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $10.76 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $10.76 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate Professional dispensing fee
Tiered or special rates Ingredient cost basis Multiple source drugs, lowest of: submitted ingredient cost, U&C, WAC, FUL, SMAC, NADAC (CMS file p. 6; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026
16 Connecticut $10.75 $10.75 -$1.25 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 no change CMS file, September 2026, p. 4
Standard fee on each dated source $11.75 $9.75 2020-12-31: $10.75, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $10.75, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $10.75, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $10.75, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $10.75, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $10.75, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $10.75 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $10.75 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate Professional dispensing fee
Tiered or special rates Ingredient cost basis Lowest of: U&C, NADAC, FUL, WAC plus 0% (CMS file p. 4; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026
17 Maryland $10.67 $10.67 -$1.33 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 between the December 2020 and September 2022 charts CMS file, September 2026, p. 12
Standard fee on each dated source $11.17 $9.99 2020-12-31: $10.49, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $10.67, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $10.67, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $10.49, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $10.67, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $10.67, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $10.67 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $10.67 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate Retail community pharmacy
Tiered or special rates $11.67 Institutional or long-term care pharmacy (source ) $12.12 340B covered entities and FQHCs (source ) Ingredient cost basis Lowest of: NADAC, WAC plus 0%, FUL, state AAC, U&C (CMS file p. 12; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026
18 Virginia $10.65 $10.65 -$1.35 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 no change CMS file, September 2026, p. 28
Standard fee on each dated source $11.65 $9.65 2020-12-31: $10.65, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $10.65, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $10.65, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $10.65, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $10.65, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $10.65, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $10.65 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $10.65 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate Professional dispensing fee
Tiered or special rates Ingredient cost basis Lowest of: NADAC, WAC, FUL, U&C (CMS file p. 28; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026
18 Wyoming $10.65 $10.65 -$1.35 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 no change CMS file, September 2026, p. 32
Standard fee on each dated source $11.65 $9.65 2020-12-31: $10.65, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $10.65, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $10.65, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $10.65, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $10.65, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $10.65, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $10.65 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $10.65 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate Professional dispensing fee
Tiered or special rates Ingredient cost basis Lowest of: NADAC (if none, WAC plus 0%), FUL, SMAC, submitted ingredient cost, GAD, U&C (CMS file p. 32; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026
20 Alabama $10.64 $10.64 -$1.36 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 no change CMS file, September 2026, p. 1
Standard fee on each dated source $11.64 $9.64 2020-12-31: $10.64, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $10.64, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $10.64, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $10.64, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $10.64, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $10.64, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $10.64 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $10.64 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate Professional dispensing fee
Tiered or special rates Ingredient cost basis Lowest of: Alabama AAC (if none, WAC plus 0% for generics), FUL, U&C (CMS file p. 1; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026
20 Kentucky $10.64 $10.64 -$1.36 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 no change Kentucky 907 KAR 23:020
Standard fee on each dated source $11.64 $9.64 2017-04-01: $10.64, Kentucky 907 KAR 23:020 (fee effective April 1 2017) 2017-04 2020-12-31: $10.64, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $10.64, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $10.64, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 April 1, 2017: $10.64, Kentucky 907 KAR 23:020 (fee effective April 1 2017) December 31, 2020: $10.64, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $10.64, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $10.64, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $10.64 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $10.64 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate Professional dispensing fee
Tiered or special rates Ingredient cost basis Lowest of: NADAC, WAC plus 0%, FUL, state MAC, U&C (CMS file p. 9; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026Kentucky 907 KAR 23:020 (fee effective April 1 2017) , checked November 4, 2026
20 Michigan $10.64 $10.64 -$1.36 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 no change CMS file, September 2026, p. 13
Standard fee on each dated source $11.64 $9.64 2020-12-31: $10.64, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $10.64, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $10.64, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $10.64, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $10.64, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $10.64, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $10.64 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $10.64 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate Drugs not on the preferred drug list
Tiered or special rates $10.80 Drugs preferred on the preferred drug list (source ) $9.00 Drugs on the preferred drug list, non-preferred (source ) $20.02 Specialty drugs (source ) Ingredient cost basis Lowest of: NADAC, WAC, MAC, U&C (CMS file p. 13; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026
23 Georgia $10.63 $10.63 -$1.37 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 no change Georgia SPA 17-0001
Standard fee on each dated source $11.63 $9.63 2017-04-01: $10.63, Georgia SPA 17-0001 (effective April 1 2017) 2017-04 2020-12-31: $10.63, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $10.63, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $10.63, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 April 1, 2017: $10.63, Georgia SPA 17-0001 (effective April 1 2017) December 31, 2020: $10.63, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $10.63, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $10.63, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $10.63 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $10.63 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate All pharmacies except low-volume independents
Tiered or special rates $11.50 Independent pharmacies with a prescription claim volume under 65,000 a year (source ) Ingredient cost basis Lowest of: Georgia MAC, Georgia estimated AAC, FUL, U&C or submitted ingredient cost (CMS file p. 5; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026Georgia SPA 17-0001 (effective April 1 2017) , checked November 4, 2026
23 Iowa $10.63 $10.63 -$1.37 +$0.25 (+2.4%)2022-09-30 to 2024-10-01 October 1, 2024 Iowa Medicaid Informational Letter 2630-MC-FFS
Standard fee on each dated source $11.13 $9.57 2020-12-31: $10.07, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $10.38, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2024-10-01: $10.63, Iowa Medicaid Informational Letter 2630-MC-FFS (effective October 1 2024) 2024-10 2026-09-30: $10.38, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 (a state source supersedes it) 2026-09 December 31, 2020: $10.07, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $10.38, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) October 1, 2024: $10.63, Iowa Medicaid Informational Letter 2630-MC-FFS (effective October 1 2024) September 30, 2026: $10.38, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ; a state source supersedes this chart value, so it is grey and off the line Change since prior source +$0.25 (+2.4%): $10.38 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $10.63 on October 1, 2024 (Iowa Medicaid Informational Letter 2630-MC-FFS (effective October 1 2024) ).
Standard rate Professional dispensing fee
Tiered or special rates Ingredient cost basis AAC from surveys; if no AAC, WAC (CMS file p. 7; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026Iowa Medicaid Informational Letter 2630-MC-FFS (effective October 1 2024) , checked November 4, 2026
25 Wisconsin $10.51 $15.69 -$1.49 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 no change CMS file, September 2026, p. 31
Standard fee on each dated source $11.51 $9.51 2020-12-31: $10.51, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $10.51, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $10.51, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $10.51, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $10.51, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $10.51, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $10.51 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $10.51 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate 35,000 or more prescriptions a year
Tiered or special rates $15.69 Fewer than 35,000 prescriptions a year (source ) $24.92 Non-tribal FQHC (source ) $7.79 Compound drug fee (source ) $9.45 Pharmaceutical care dispensing fee, lowest (source ) $40.11 Pharmaceutical care dispensing fee, highest (source ) Ingredient cost basis Lowest of: NADAC, U&C; if no NADAC, WAC, SMAC, U&C (CMS file p. 31; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026
26 Arkansas $10.50 $10.50 -$1.50 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 no change Arkansas SPA 16-003
Standard fee on each dated source $11.50 $9.50 2017-04-01: $10.50, Arkansas SPA 16-003 (effective April 1 2017) 2017-04 2020-12-31: $10.50, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $10.50, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $10.50, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 April 1, 2017: $10.50, Arkansas SPA 16-003 (effective April 1 2017) December 31, 2020: $10.50, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $10.50, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $10.50, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $10.50 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $10.50 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate Preferred brand and generics
Tiered or special rates $9.00 Brand and non-preferred brand (source ) Ingredient cost basis Lowest of: NADAC (WAC if no NADAC), state AAC, FUL (CMS file p. 2; source )
Sources Arkansas SPA 16-003 (effective April 1 2017) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026
26 Kansas $10.50 $10.50 -$1.50 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 no change CMS file, September 2026, p. 8
Standard fee on each dated source $11.50 $9.50 2020-12-31: $10.50, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $10.50, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $10.50, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $10.50, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $10.50, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $10.50, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $10.50 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $10.50 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate Professional dispensing fee
Tiered or special rates Ingredient cost basis Lowest of: NADAC, WAC, FUL, SMAC, submitted ingredient cost, U&C (CMS file p. 8; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026
26 South Carolina $10.50 $10.50 -$1.50 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 no change CMS file, September 2026, p. 23
Standard fee on each dated source $11.50 $9.50 2020-12-31: $10.50, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $10.50, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $10.50, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $10.50, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $10.50, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $10.50, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $10.50 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $10.50 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate Professional dispensing fee
Tiered or special rates Ingredient cost basis Lowest of: NADAC (if none, WAC minus 0%), SMAC, U&C (CMS file p. 23; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026
26 South Dakota $10.50 $10.50 -$1.50 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 no change CMS file, September 2026, p. 23
Standard fee on each dated source $11.50 $9.50 2020-12-31: $10.50, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $10.50, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $10.50, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $10.50, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $10.50, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $10.50, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $10.50 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $10.50 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate Professional dispensing fee
Tiered or special rates Ingredient cost basis U&C, SMAC, NADAC, or WAC (CMS file p. 23; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026
30 West Virginia $10.49 $10.49 -$1.51 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 no change West Virginia BMS notice on pharmacy pricing methodology changes
Standard fee on each dated source $11.49 $9.49 2017-06-21: $10.49, West Virginia BMS notice on pharmacy pricing methodology changes (fee effective June 21 2017) 2017-06 2020-12-31: $10.49, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $10.49, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $10.49, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 June 21, 2017: $10.49, West Virginia BMS notice on pharmacy pricing methodology changes (fee effective June 21 2017) December 31, 2020: $10.49, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $10.49, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $10.49, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $10.49 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $10.49 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate Professional dispensing fee
Tiered or special rates Ingredient cost basis Lowest of: NADAC (if none, WAC plus 0%), FUL, SMAC, submitted ingredient cost, U&C (CMS file p. 30; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026West Virginia BMS notice on pharmacy pricing methodology changes (fee effective June 21 2017) , checked November 4, 2026
31 Indiana $10.48 $10.48 -$1.52 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 no change CMS file, September 2026, p. 7
Standard fee on each dated source $11.48 $9.48 2020-12-31: $10.48, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $10.48, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $10.48, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $10.48, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $10.48, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $10.48, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $10.48 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $10.48 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate Professional dispensing fee
Tiered or special rates Ingredient cost basis Lowest of: NADAC, state MAC, FUL, WAC (CMS file p. 7; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026
32 New Hampshire $10.47 $10.47 -$1.53 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 no change New Hampshire SPA 17-0003
Standard fee on each dated source $11.47 $9.47 2017-04-01: $10.47, New Hampshire SPA 17-0003 (effective April 1 2017) 2017-04 2020-12-31: $10.47, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $10.47, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $10.47, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 April 1, 2017: $10.47, New Hampshire SPA 17-0003 (effective April 1 2017) December 31, 2020: $10.47, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $10.47, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $10.47, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $10.47 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $10.47 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate Professional dispensing fee
Tiered or special rates Ingredient cost basis Lowest of: NADAC, WAC plus 0%, SMAC, FUL, U&C (CMS file p. 17; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026New Hampshire SPA 17-0003 (effective April 1 2017) , checked November 4, 2026
33 New Mexico $10.30 $10.30 -$1.70 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 no change CMS file, September 2026, p. 18
Standard fee on each dated source $11.30 $9.30 2020-12-31: $10.30, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $10.30, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $10.30, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $10.30, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $10.30, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $10.30, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $10.30 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $10.30 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate Professional dispensing fee
Tiered or special rates Ingredient cost basis Lowest of: FUL, NADAC, WAC, U&C (CMS file p. 18; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026
34 Florida $10.24 $10.24 -$1.76 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 no change CMS file, September 2026, p. 5
Standard fee on each dated source $11.24 $9.24 2020-12-31: $10.24, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $10.24, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $10.24, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $10.24, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $10.24, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $10.24, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $10.24 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $10.24 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate Professional dispensing fee
Tiered or special rates Ingredient cost basis Lowest of: NADAC, WAC plus 0%, SMAC, U&C (CMS file p. 5; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026
34 North Carolina $10.24 $10.24 -$1.76 +$0.00 (+0.0%)2022-12-01 to 2026-09-30; in effect since December 1, 2022 (down from $13.00) December 1, 2022 North Carolina SPA 22-0033
Standard fee on each dated source $13.50 $9.74 2020-12-31: $13.00, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $13.00, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2022-12-01: $10.24, North Carolina SPA 22-0033 (effective December 1 2022) 2022-12 2026-09-30: $10.24, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $13.00, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $13.00, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) December 1, 2022: $10.24, North Carolina SPA 22-0033 (effective December 1 2022) September 30, 2026: $10.24, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $10.24 on December 1, 2022 (North Carolina SPA 22-0033 (effective December 1 2022) ) to $10.24 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ). The fee was in effect since December 1, 2022 (down from $13.00).
Standard rate Professional dispensing fee
Tiered or special rates Ingredient cost basis Lowest of: NADAC, MAC, U&C, GAD (CMS file p. 19; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026North Carolina SPA 22-0033 (effective December 1 2022) , checked November 4, 2026
36 New York $10.18 $10.18 -$1.82 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 between the December 2020 and September 2022 charts CMS file, September 2026, p. 18
Standard fee on each dated source $10.68 $9.58 2020-12-31: $10.08, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $10.18, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $10.18, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $10.08, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $10.18, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $10.18, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $10.18 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $10.18 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate Professional dispensing fee
Tiered or special rates Ingredient cost basis Lowest of: NADAC, WAC, WAC minus 17.5% (generic), FUL, SMAC, U&C (CMS file p. 18; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026
37 Nevada $10.17 $10.17 -$1.83 +$0.00 (+0.0%)2023-12-01 to 2026-09-30 no change Nevada SPA 23-0014
Standard fee on each dated source $11.17 $9.17 2020-12-31: $10.17, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $10.17, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2023-12-01: $10.17, Nevada SPA 23-0014 (effective December 1 2023) 2023-12 2026-09-30: $10.17, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $10.17, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $10.17, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) December 1, 2023: $10.17, Nevada SPA 23-0014 (effective December 1 2023) September 30, 2026: $10.17, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $10.17 on December 1, 2023 (Nevada SPA 23-0014 (effective December 1 2023) ) to $10.17 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate Professional dispensing fee
Tiered or special rates Ingredient cost basis Lowest of: NADAC, FUL, SMAC, U&C (CMS file p. 17; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026Nevada SPA 23-0014 (effective December 1 2023) , checked November 4, 2026
38 Arizona $10.11 $10.11 -$1.89 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 no change CMS file, September 2026, p. 2
Standard fee on each dated source $11.11 $9.11 2020-12-31: $10.11, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $10.11, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $10.11, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $10.11, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $10.11, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $10.11, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $10.11 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $10.11 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate Covered outpatient drugs
Tiered or special rates $15.34 Compounded prescriptions (source ) Ingredient cost basis U&C, AHCCCS MAC, NADAC, or contracted rates with the FFS pharmacy benefit manager (CMS file p. 2; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026
39 California $10.05 $13.20 -$1.95 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 no change CMS file, September 2026, p. 2
Standard fee on each dated source $11.05 $9.05 2020-12-31: $10.05, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $10.05, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $10.05, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $10.05, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $10.05, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $10.05, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $10.05 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $10.05 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate Pharmacies with 90,000 claims or more a year
Tiered or special rates $13.20 Pharmacies with fewer than 90,000 claims a year (source ) Ingredient cost basis Lowest of: NADAC (if none, WAC plus 0%), FUL, MAIC (CMS file p. 2; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026
40 Massachusetts $10.02 $10.02 -$1.98 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 no change CMS file, September 2026, p. 13
Standard fee on each dated source $11.02 $9.02 2020-12-31: $10.02, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $10.02, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $10.02, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $10.02, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $10.02, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $10.02, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $10.02 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $10.02 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate Professional dispensing fee
Tiered or special rates Ingredient cost basis Lowest of: FUL, WAC, NADAC, U&C (CMS file p. 13; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026
40 Nebraska $10.02 $10.02 -$1.98 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 no change CMS file, September 2026, p. 16
Standard fee on each dated source $11.02 $9.02 2020-12-31: $10.02, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $10.02, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $10.02, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $10.02, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $10.02, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $10.02, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $10.02 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $10.02 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate Professional dispensing fee
Tiered or special rates Ingredient cost basis Lowest of: NADAC, FUL, MAC, U&C (CMS file p. 16; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026
42 Delaware $10.00 $10.00 -$2.00 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 no change CMS file, September 2026, p. 4
Standard fee on each dated source $11.00 $9.00 2020-12-31: $10.00, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $10.00, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $10.00, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $10.00, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $10.00, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $10.00, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $10.00 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $10.00 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate Professional dispensing fee
Tiered or special rates Ingredient cost basis NADAC; if none, Delaware MAC; if none, WAC plus 2% (legend); or U&C (CMS file p. 4; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026
42 Pennsylvania $10.00 $10.00 -$2.00 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 no change CMS file, September 2026, p. 22
Standard fee on each dated source $11.00 $9.00 2020-12-31: $10.00, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $10.00, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $10.00, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $10.00, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $10.00, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $10.00, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $10.00 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $10.00 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate Professional dispensing fee
Tiered or special rates Ingredient cost basis Generics, lowest of: U&C, NADAC (if none, WAC minus 50.5%), FUL, state MAC (CMS file p. 22; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026
44 Oregon $9.99 $16.87 -$2.01 +$0.00 (+0.0%)2024-11-01 to 2026-09-30; in effect since November 1, 2024 (up from $9.80) November 1, 2024 Oregon SPA 24-0019
Standard fee on each dated source $10.49 $9.30 2020-12-31: $9.80, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $9.80, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2024-11-01: $9.99, Oregon SPA 24-0019 (effective November 1 2024) 2024-11 2026-09-30: $9.99, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $9.80, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $9.80, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) November 1, 2024: $9.99, Oregon SPA 24-0019 (effective November 1 2024) September 30, 2026: $9.99, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $9.99 on November 1, 2024 (Oregon SPA 24-0019 (effective November 1 2024) ) to $9.99 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ). The fee was in effect since November 1, 2024 (up from $9.80).
Standard rate 80,000 or more claims a year
Tiered or special rates $11.93 40,000 to 79,999 claims a year (source ) $16.87 Fewer than 40,000 claims a year (source ) $20.86 340B covered entities (source ) Ingredient cost basis Lowest of: Oregon AAC file, NADAC, WAC plus 0%, U&C (CMS file p. 22; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026Oregon SPA 24-0019 (effective November 1 2024) , checked November 4, 2026
45 Washington $9.80 $14.30 -$2.20 +$0.00 (+0.0%)2023-07-01 to 2026-09-30; in effect since July 1, 2023 (up from $4.24) July 1, 2023 Washington SPA 23-0050
Standard fee on each dated source $10.30 $3.74 2020-12-31: $4.24, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $4.24, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2023-07-01: $9.80, Washington SPA 23-0050 (effective July 1 2023) 2023-07 2026-09-30: $9.80, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $4.24, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $4.24, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) July 1, 2023: $9.80, Washington SPA 23-0050 (effective July 1 2023) September 30, 2026: $9.80, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $9.80 on July 1, 2023 (Washington SPA 23-0050 (effective July 1 2023) ) to $9.80 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ). The fee was in effect since July 1, 2023 (up from $4.24).
Standard rate 70,000 or more prescriptions a year
Tiered or special rates $11.91 30,000 to 69,999 prescriptions a year (source ) $14.30 Fewer than 30,000 prescriptions a year (source ) $14.30 Unit dose systems (source ) Ingredient cost basis AAC, the lowest of NADAC, MAC, FUL, U&C, submitted ingredient cost; WAC where there is no NADAC (CMS file p. 29; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026Washington SPA 23-0050 (effective July 1 2023) , checked November 4, 2026
46 Colorado $9.31 $13.40 -$2.69 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 no change CMS file, September 2026, p. 3
Standard fee on each dated source $10.31 $8.31 2020-12-31: $9.31, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $9.31, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $9.31, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $9.31, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $9.31, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $9.31, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $9.31 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $9.31 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate More than 110,000 prescriptions a year
Tiered or special rates $10.25 90,000 to 110,000 prescriptions a year (source ) $11.49 60,000 to 90,000 prescriptions a year (source ) $13.40 Fewer than 60,000 prescriptions a year (source ) $14.14 Rural pharmacies (source ) $0.00 Government pharmacies (source ) $73.21 Parenteral nutrition products (source ) Ingredient cost basis Lower of U&C and the allowed ingredient cost (lowest of AAC, NADAC, submitted ingredient cost; if no AAC or NADAC, MAC) (CMS file p. 3; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026
47 Tennessee $9.02 $13.16 -$2.98 +$0.00 (+0.0%)2023-11-01 to 2026-09-30; in effect since November 1, 2023 (up from $8.37) November 1, 2023 Tennessee SPA 23-0005
Standard fee on each dated source $9.52 $7.87 2020-12-31: $8.37, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $8.37, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2023-11-01: $9.02, Tennessee SPA 23-0005 (effective November 1 2023) 2023-11 2026-09-30: $9.02, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $8.37, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $8.37, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) November 1, 2023: $9.02, Tennessee SPA 23-0005 (effective November 1 2023) September 30, 2026: $9.02, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $9.02 on November 1, 2023 (Tennessee SPA 23-0005 (effective November 1 2023) ) to $9.02 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ). The fee was in effect since November 1, 2023 (up from $8.37).
Standard rate Ambulatory pharmacies with 65,000 or more claims a year
Tiered or special rates $13.16 Ambulatory pharmacies under 65,000 claims a year, and long-term care (source ) $16.92 340B claims (source ) $52.46 Specialty drugs (source ) $172.69 Blood clotting factors (source ) $5.00 Pharmacies that fail three cost surveys (source ) $13.16 Out-of-state pharmacies under 65,000 claims in border areas (source ) $9.02 All other out-of-state pharmacies (source ) Ingredient cost basis Lowest of: FUL, AAAC, NADAC, WAC minus 6% (generics, if no AAAC or NADAC), U&C (CMS file p. 24; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026Tennessee SPA 23-0005 (effective November 1 2023) , checked November 4, 2026
48 Rhode Island $8.96 $8.96 -$3.04 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 no change CMS file, September 2026, p. 23
Standard fee on each dated source $9.96 $7.96 2020-12-31: $8.96, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $8.96, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $8.96, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $8.96, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $8.96, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $8.96, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $8.96 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $8.96 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate Members not in long-term care
Tiered or special rates $7.90 Members in long-term care (source ) Ingredient cost basis Lowest of: NADAC, WAC plus 0%, FUL, SMAC, FDB SWD minus 19%, U&C (CMS file p. 23; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026
49 Illinois $8.85 $8.85 -$3.15 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 no change CMS file, September 2026, p. 7
Standard fee on each dated source $9.85 $7.85 2020-12-31: $8.85, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $8.85, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $8.85, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $8.85, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $8.85, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $8.85, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $8.85 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $8.85 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate All pharmacies except critical access pharmacies
Tiered or special rates $15.55 Critical access pharmacies (source ) $207.00 Hemophilia treatment centers for 340B antihemophilic products (source ) Ingredient cost basis Multiple source drugs, lowest of: U&C, NADAC, WAC minus 17.5%, FUL, state upper limit (CMS file p. 7; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026
50 Ohio $8.30 $15.47 -$3.70 +$0.00 (+0.0%)2022-09-30 to 2026-09-30 no change CMS file, September 2026, p. 21
Standard fee on each dated source $9.30 $7.30 2020-12-31: $8.30, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 2020-12 2022-09-30: $8.30, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) 2022-09 2026-09-30: $8.30, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 2026-09 December 31, 2020: $8.30, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: $8.30, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: $8.30, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source +$0.00 (+0.0%): $8.30 on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to $8.30 on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate 100,000 or more prescriptions a year
Tiered or special rates $9.51 75,000 to 99,999 prescriptions a year (source ) $11.40 50,000 to 74,999 prescriptions a year (source ) $15.47 Fewer than 50,000 prescriptions a year (source ) Ingredient cost basis Lower of NADAC and U&C; if no NADAC, lowest of WAC plus 0%, SMAC, U&C (CMS file p. 21; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026
51 Texas formula formula not computed formula, no change computed2022-09-30 to 2026-09-30 no change Texas SPA 17-0011
Standard fee on each dated source The fee is a formula, so there is no line to draw.
April 1, 2017: formula, Texas SPA 17-0011 (effective April 1 2017) December 31, 2020: formula, CMS reimbursement information by state, PDF titled Quarter Ending December 2020 September 30, 2022: formula, CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) September 30, 2026: formula, CMS reimbursement information by state, PDF titled Quarter Ending September 2026 Change since prior source formula, no change computed: formula on September 30, 2022 (CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) ) to formula on September 30, 2026 (CMS reimbursement information by state, PDF titled Quarter Ending September 2026 ).
Standard rate Formula: ((NADAC + $7.93) / (1 - 1.96%)) - NADAC
Tiered or special rates Ingredient cost basis Retail: NADAC; if none, WAC minus 2% (CMS file p. 26; source )
Sources CMS reimbursement information by state, PDF titled Quarter Ending December 2020 , checked November 4, 2026CMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022) , checked November 4, 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026 , checked November 4, 2026Texas SPA 17-0011 (effective April 1 2017) , checked November 4, 2026