{ "as_of": "2026-11-04", "baseline": 12.0, "summary": { "n": 50, "mean": 10.5834, "median": 10.505, "juris": 51, "lowest_volume_mean": 11.4514, "lowest_volume_median": 10.65, "volume_states": [ "CA", "CO", "ID", "MT", "OH", "OR", "TN", "WA", "WI" ], "changed_2020": 13, "window": 0, "earlier": 51, "no_prior": 0, "since": 9 }, "states": [ { "state": "MT", "name": "Montana", "rank": 1, "standard_fee": 12.83, "lowest_volume_tier_fee": 17.52, "lowest_volume_tier_rate": "Fewer than 40,000 prescriptions a year", "gap": 0.83, "color": "green", "standard_rate": "70,000 or more prescriptions a year", "other_rates": [ { "label": "40,000 to 69,999 prescriptions a year", "fee": 15.17, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid/spa/downloads/MT-25-0016.pdf" }, { "label": "Fewer than 40,000 prescriptions a year", "fee": 17.52, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid/spa/downloads/MT-25-0016.pdf" } ], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2025-07-01", "to_date": "2026-09-30" }, "changed_since": "2025-07-01", "ingredient_cost_basis": "Lowest of: AAC, submitted ingredient cost, WAC, FUL", "ingredient_page": 16, "source_url": "https://www.medicaid.gov/medicaid/spa/downloads/MT-25-0016.pdf", "history": [ { "date": "2020-12-31", "fee": 11.3, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 11.41, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2025-07-01", "fee": 12.83, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/spa/downloads/MT-25-0016.pdf" }, { "date": "2026-09-30", "fee": 12.83, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "ND", "name": "North Dakota", "rank": 2, "standard_fee": 12.46, "lowest_volume_tier_fee": 12.46, "lowest_volume_tier_rate": "Professional dispensing fee", "gap": 0.46, "color": "green", "standard_rate": "Professional dispensing fee", "other_rates": [ { "label": "Pill splitting, added per pill", "fee": 0.15, "unit": "per_unit", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2025-01-01", "to_date": "2026-09-30" }, "changed_since": "", "ingredient_cost_basis": "Lowest of: NADAC, WAC, MAC, U&C", "ingredient_page": 20, "source_url": "https://www.medicaid.gov/medicaid/spa/downloads/ND-25-0007.pdf", "history": [ { "date": "2019-07-01", "fee": 12.46, "superseded": "no", "source_url": "https://www.medicaid.gov/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/ND/ND-19-0004.pdf" }, { "date": "2020-12-31", "fee": 12.46, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 12.46, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2025-01-01", "fee": 12.46, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/spa/downloads/ND-25-0007.pdf" }, { "date": "2026-09-30", "fee": 12.46, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "MO", "name": "Missouri", "rank": 3, "standard_fee": 12.22, "lowest_volume_tier_fee": 12.22, "lowest_volume_tier_rate": "In-state pharmacy, before the reimbursement allowance adjustment", "gap": 0.22, "color": "green", "standard_rate": "In-state pharmacy, before the reimbursement allowance adjustment", "other_rates": [ { "label": "Out-of-state pharmacy", "fee": 8.85, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid/spa/downloads/MO-21-0008.pdf" }, { "label": "Long-term care pharmacies, added to the fee", "fee": 0.5, "unit": "add_on", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2021-02-01", "to_date": "2026-09-30" }, "changed_since": "2021-02-01", "ingredient_cost_basis": "NADAC; if none, state MAC; if neither, WAC; or U&C if lower", "ingredient_page": 15, "source_url": "https://www.medicaid.gov/medicaid/spa/downloads/MO-21-0008.pdf", "history": [ { "date": "2020-12-31", "fee": 4.09, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2021-02-01", "fee": 12.22, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/spa/downloads/MO-21-0008.pdf" }, { "date": "2022-09-30", "fee": 4.09, "superseded": "yes", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 12.22, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "ME", "name": "Maine", "rank": 4, "standard_fee": 11.89, "lowest_volume_tier_fee": 11.89, "lowest_volume_tier_rate": "Professional dispensing fee", "gap": -0.11, "color": "yellow", "standard_rate": "Professional dispensing fee", "other_rates": [], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "", "ingredient_cost_basis": "Generics, lowest of: NADAC, FUL, WAC, state MAC, submitted ingredient cost, U&C, GAD, AWP minus 16.67%", "ingredient_page": 10, "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf", "history": [ { "date": "2020-12-31", "fee": 11.89, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 11.89, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 11.89, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "LA", "name": "Louisiana", "rank": 5, "standard_fee": 11.81, "lowest_volume_tier_fee": 11.81, "lowest_volume_tier_rate": "Professional dispensing fee", "gap": -0.19, "color": "yellow", "standard_rate": "Professional dispensing fee", "other_rates": [], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2023-10-01", "to_date": "2026-09-30" }, "changed_since": "2023-10-01", "ingredient_cost_basis": "Generics, lowest of: NADAC, WAC, FUL, U&C", "ingredient_page": 9, "source_url": "https://www.medicaid.gov/medicaid/spa/downloads/LA-23-0024.pdf", "history": [ { "date": "2020-12-31", "fee": 10.99, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 10.99, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2023-10-01", "fee": 11.81, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/spa/downloads/LA-23-0024.pdf" }, { "date": "2026-09-30", "fee": 11.81, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "AK", "name": "Alaska", "rank": 6, "standard_fee": 11.8, "lowest_volume_tier_fee": 11.8, "lowest_volume_tier_rate": "On the road system, non-tribal pharmacy", "gap": -0.2, "color": "yellow", "standard_rate": "On the road system, non-tribal pharmacy", "other_rates": [ { "label": "Off the road system, non-tribal pharmacy", "fee": 22.17, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid/spa/downloads/AK-25-0006.pdf" }, { "label": "Tribal health pharmacy", "fee": 26.81, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" }, { "label": "Out-of-state pharmacy", "fee": 10.76, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" }, { "label": "Mediset pharmacy", "fee": 16.58, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2025-07-01", "to_date": "2026-09-30" }, "changed_since": "2025-07-01", "ingredient_cost_basis": "Lowest of: amount billed, WAC plus 1%, SMAC (set at NADAC), FUL (in-state pharmacies)", "ingredient_page": 1, "source_url": "https://www.medicaid.gov/medicaid/spa/downloads/AK-25-0006.pdf", "history": [ { "date": "2020-12-31", "fee": 13.36, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 13.36, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2025-07-01", "fee": 11.8, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/spa/downloads/AK-25-0006.pdf" }, { "date": "2026-09-30", "fee": 11.8, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "UT", "name": "Utah", "rank": 7, "standard_fee": 11.57, "lowest_volume_tier_fee": 11.57, "lowest_volume_tier_rate": "All prescriptions except hemophilia clotting factor", "gap": -0.43, "color": "yellow", "standard_rate": "All prescriptions except hemophilia clotting factor", "other_rates": [ { "label": "Hemophilia clotting factor", "fee": 97.53, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid/spa/downloads/UT-24-0017.pdf" } ], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2024-07-15", "to_date": "2026-09-30" }, "changed_since": "2024-07-15", "ingredient_cost_basis": "Lowest of: WAC, FUL, Utah MAC (NADAC), submitted ingredient cost", "ingredient_page": 27, "source_url": "https://www.medicaid.gov/medicaid/spa/downloads/UT-24-0017.pdf", "history": [ { "date": "2020-12-31", "fee": 9.99, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 9.99, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2024-07-15", "fee": 11.57, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/spa/downloads/UT-24-0017.pdf" }, { "date": "2026-09-30", "fee": 11.57, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "MN", "name": "Minnesota", "rank": 8, "standard_fee": 11.55, "lowest_volume_tier_fee": 11.55, "lowest_volume_tier_rate": "Professional dispensing fee", "gap": -0.45, "color": "yellow", "standard_rate": "Professional dispensing fee", "other_rates": [ { "label": "Prescribed OTC drugs that are not covered outpatient drugs", "fee": 3.65, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ], "change": { "dollars": 1.07, "pct": 0.10209923664122138, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2024-10-01" }, "changed_since": "2024-10-01", "ingredient_cost_basis": "Lowest of: NADAC, state MAC, U&C; if neither NADAC nor MAC, WAC minus 2%", "ingredient_page": 14, "source_url": "https://www.medicaid.gov/medicaid/spa/downloads/MN-24-0034.pdf", "history": [ { "date": "2020-12-31", "fee": 10.48, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 10.48, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2024-10-01", "fee": 11.55, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/spa/downloads/MN-24-0034.pdf" }, { "date": "2026-09-30", "fee": 10.77, "superseded": "yes", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "ID", "name": "Idaho", "rank": 9, "standard_fee": 11.51, "lowest_volume_tier_fee": 15.11, "lowest_volume_tier_rate": "Fewer than 40,000 claims a year", "gap": -0.49, "color": "yellow", "standard_rate": "70,000 or more claims a year", "other_rates": [ { "label": "40,000 to 69,999 claims a year", "fee": 12.35, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" }, { "label": "Fewer than 40,000 claims a year", "fee": 15.11, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "", "ingredient_cost_basis": "AAC; if no AAC, WAC", "ingredient_page": 6, "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf", "history": [ { "date": "2020-12-31", "fee": 11.51, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 11.51, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 11.51, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "MS", "name": "Mississippi", "rank": 10, "standard_fee": 11.29, "lowest_volume_tier_fee": 11.29, "lowest_volume_tier_rate": "Professional dispensing fee", "gap": -0.71, "color": "yellow", "standard_rate": "Professional dispensing fee", "other_rates": [ { "label": "Specialty drugs dispensed mainly by mail", "fee": 61.14, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "", "ingredient_cost_basis": "Lowest of: NADAC (if none, WAC plus 0%), a rate set by the state's rate-setting vendor, U&C", "ingredient_page": 14, "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf", "history": [ { "date": "2020-12-31", "fee": 11.29, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 11.29, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 11.29, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "DC", "name": "District of Columbia", "rank": 11, "standard_fee": 11.15, "lowest_volume_tier_fee": 11.15, "lowest_volume_tier_rate": "Professional dispensing fee", "gap": -0.85, "color": "yellow", "standard_rate": "Professional dispensing fee", "other_rates": [], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "", "ingredient_cost_basis": "Multiple source drugs, lowest of: FUL, NADAC, WAC, U&C, District MAC", "ingredient_page": 5, "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf", "history": [ { "date": "2020-12-31", "fee": 11.15, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 11.15, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 11.15, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "VT", "name": "Vermont", "rank": 12, "standard_fee": 11.13, "lowest_volume_tier_fee": 11.13, "lowest_volume_tier_rate": "Retail community, institutional or long-term care pharmacy", "gap": -0.87, "color": "yellow", "standard_rate": "Retail community, institutional or long-term care pharmacy", "other_rates": [ { "label": "Specialty drugs", "fee": 17.03, "unit": "per_rx", "source_url": "https://www.medicaid.gov/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/VT/VT-17-0005.pdf" } ], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "", "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", "ingredient_page": 28, "source_url": "https://www.medicaid.gov/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/VT/VT-17-0005.pdf", "history": [ { "date": "2017-04-01", "fee": 11.13, "superseded": "no", "source_url": "https://www.medicaid.gov/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/VT/VT-17-0005.pdf" }, { "date": "2020-12-31", "fee": 11.13, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 11.13, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 11.13, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "NJ", "name": "New Jersey", "rank": 13, "standard_fee": 10.92, "lowest_volume_tier_fee": 10.92, "lowest_volume_tier_rate": "Professional dispensing fee", "gap": -1.08, "color": "none", "standard_rate": "Professional dispensing fee", "other_rates": [], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "", "ingredient_cost_basis": "NADAC, WAC minus 2%, or SWP minus 19%", "ingredient_page": 17, "source_url": "https://www.medicaid.gov/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/NJ/NJ-17-0002.pdf", "history": [ { "date": "2017-04-01", "fee": 10.92, "superseded": "no", "source_url": "https://www.medicaid.gov/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/NJ/NJ-17-0002.pdf" }, { "date": "2020-12-31", "fee": 10.92, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 10.92, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 10.92, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "OK", "name": "Oklahoma", "rank": 14, "standard_fee": 10.87, "lowest_volume_tier_fee": 10.87, "lowest_volume_tier_rate": "Professional dispensing fee", "gap": -1.13, "color": "none", "standard_rate": "Professional dispensing fee", "other_rates": [], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "", "ingredient_cost_basis": "Generics, lowest of: state MAC, NADAC, WAC", "ingredient_page": 21, "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf", "history": [ { "date": "2020-12-31", "fee": 10.87, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 10.87, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 10.87, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "HI", "name": "Hawaii", "rank": 15, "standard_fee": 10.76, "lowest_volume_tier_fee": 10.76, "lowest_volume_tier_rate": "Professional dispensing fee", "gap": -1.24, "color": "none", "standard_rate": "Professional dispensing fee", "other_rates": [], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "", "ingredient_cost_basis": "Multiple source drugs, lowest of: submitted ingredient cost, U&C, WAC, FUL, SMAC, NADAC", "ingredient_page": 6, "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf", "history": [ { "date": "2020-12-31", "fee": 10.76, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 10.76, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 10.76, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "CT", "name": "Connecticut", "rank": 16, "standard_fee": 10.75, "lowest_volume_tier_fee": 10.75, "lowest_volume_tier_rate": "Professional dispensing fee", "gap": -1.25, "color": "none", "standard_rate": "Professional dispensing fee", "other_rates": [], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "", "ingredient_cost_basis": "Lowest of: U&C, NADAC, FUL, WAC plus 0%", "ingredient_page": 4, "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf", "history": [ { "date": "2020-12-31", "fee": 10.75, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 10.75, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 10.75, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "MD", "name": "Maryland", "rank": 17, "standard_fee": 10.67, "lowest_volume_tier_fee": 10.67, "lowest_volume_tier_rate": "Retail community pharmacy", "gap": -1.33, "color": "none", "standard_rate": "Retail community pharmacy", "other_rates": [ { "label": "Institutional or long-term care pharmacy", "fee": 11.67, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" }, { "label": "340B covered entities and FQHCs", "fee": 12.12, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "between 2020-12-31 and 2022-09-30", "ingredient_cost_basis": "Lowest of: NADAC, WAC plus 0%, FUL, state AAC, U&C", "ingredient_page": 12, "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf", "history": [ { "date": "2020-12-31", "fee": 10.49, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 10.67, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 10.67, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "VA", "name": "Virginia", "rank": 18, "standard_fee": 10.65, "lowest_volume_tier_fee": 10.65, "lowest_volume_tier_rate": "Professional dispensing fee", "gap": -1.35, "color": "none", "standard_rate": "Professional dispensing fee", "other_rates": [], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "", "ingredient_cost_basis": "Lowest of: NADAC, WAC, FUL, U&C", "ingredient_page": 28, "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf", "history": [ { "date": "2020-12-31", "fee": 10.65, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 10.65, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 10.65, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "WY", "name": "Wyoming", "rank": 18, "standard_fee": 10.65, "lowest_volume_tier_fee": 10.65, "lowest_volume_tier_rate": "Professional dispensing fee", "gap": -1.35, "color": "none", "standard_rate": "Professional dispensing fee", "other_rates": [], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "", "ingredient_cost_basis": "Lowest of: NADAC (if none, WAC plus 0%), FUL, SMAC, submitted ingredient cost, GAD, U&C", "ingredient_page": 32, "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf", "history": [ { "date": "2020-12-31", "fee": 10.65, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 10.65, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 10.65, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "AL", "name": "Alabama", "rank": 20, "standard_fee": 10.64, "lowest_volume_tier_fee": 10.64, "lowest_volume_tier_rate": "Professional dispensing fee", "gap": -1.36, "color": "none", "standard_rate": "Professional dispensing fee", "other_rates": [], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "", "ingredient_cost_basis": "Lowest of: Alabama AAC (if none, WAC plus 0% for generics), FUL, U&C", "ingredient_page": 1, "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf", "history": [ { "date": "2020-12-31", "fee": 10.64, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 10.64, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 10.64, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "KY", "name": "Kentucky", "rank": 20, "standard_fee": 10.64, "lowest_volume_tier_fee": 10.64, "lowest_volume_tier_rate": "Professional dispensing fee", "gap": -1.36, "color": "none", "standard_rate": "Professional dispensing fee", "other_rates": [], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "", "ingredient_cost_basis": "Lowest of: NADAC, WAC plus 0%, FUL, state MAC, U&C", "ingredient_page": 9, "source_url": "https://apps.legislature.ky.gov/law/kar/titles/907/023/020/", "history": [ { "date": "2017-04-01", "fee": 10.64, "superseded": "no", "source_url": "https://apps.legislature.ky.gov/law/kar/titles/907/023/020/" }, { "date": "2020-12-31", "fee": 10.64, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 10.64, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 10.64, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "MI", "name": "Michigan", "rank": 20, "standard_fee": 10.64, "lowest_volume_tier_fee": 10.64, "lowest_volume_tier_rate": "Drugs not on the preferred drug list", "gap": -1.36, "color": "none", "standard_rate": "Drugs not on the preferred drug list", "other_rates": [ { "label": "Drugs preferred on the preferred drug list", "fee": 10.8, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" }, { "label": "Drugs on the preferred drug list, non-preferred", "fee": 9.0, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" }, { "label": "Specialty drugs", "fee": 20.02, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "", "ingredient_cost_basis": "Lowest of: NADAC, WAC, MAC, U&C", "ingredient_page": 13, "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf", "history": [ { "date": "2020-12-31", "fee": 10.64, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 10.64, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 10.64, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "GA", "name": "Georgia", "rank": 23, "standard_fee": 10.63, "lowest_volume_tier_fee": 10.63, "lowest_volume_tier_rate": "All pharmacies except low-volume independents", "gap": -1.37, "color": "none", "standard_rate": "All pharmacies except low-volume independents", "other_rates": [ { "label": "Independent pharmacies with a prescription claim volume under 65,000 a year", "fee": 11.5, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "", "ingredient_cost_basis": "Lowest of: Georgia MAC, Georgia estimated AAC, FUL, U&C or submitted ingredient cost", "ingredient_page": 5, "source_url": "https://www.medicaid.gov/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/GA/GA-17-0001.pdf", "history": [ { "date": "2017-04-01", "fee": 10.63, "superseded": "no", "source_url": "https://www.medicaid.gov/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/GA/GA-17-0001.pdf" }, { "date": "2020-12-31", "fee": 10.63, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 10.63, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 10.63, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "IA", "name": "Iowa", "rank": 23, "standard_fee": 10.63, "lowest_volume_tier_fee": 10.63, "lowest_volume_tier_rate": "Professional dispensing fee", "gap": -1.37, "color": "none", "standard_rate": "Professional dispensing fee", "other_rates": [], "change": { "dollars": 0.25, "pct": 0.024084778420038536, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2024-10-01" }, "changed_since": "2024-10-01", "ingredient_cost_basis": "AAC from surveys; if no AAC, WAC", "ingredient_page": 7, "source_url": "https://nacds.org/ceo/2024/1010/IA-INFO-LETTER-NO-2630-MC-FFS-2024_Pharmacy_Dispensing_Fee_Increase.pdf", "history": [ { "date": "2020-12-31", "fee": 10.07, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 10.38, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2024-10-01", "fee": 10.63, "superseded": "no", "source_url": "https://nacds.org/ceo/2024/1010/IA-INFO-LETTER-NO-2630-MC-FFS-2024_Pharmacy_Dispensing_Fee_Increase.pdf" }, { "date": "2026-09-30", "fee": 10.38, "superseded": "yes", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "WI", "name": "Wisconsin", "rank": 25, "standard_fee": 10.51, "lowest_volume_tier_fee": 15.69, "lowest_volume_tier_rate": "Fewer than 35,000 prescriptions a year", "gap": -1.49, "color": "none", "standard_rate": "35,000 or more prescriptions a year", "other_rates": [ { "label": "Fewer than 35,000 prescriptions a year", "fee": 15.69, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" }, { "label": "Non-tribal FQHC", "fee": 24.92, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" }, { "label": "Compound drug fee", "fee": 7.79, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" }, { "label": "Pharmaceutical care dispensing fee, lowest", "fee": 9.45, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" }, { "label": "Pharmaceutical care dispensing fee, highest", "fee": 40.11, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "", "ingredient_cost_basis": "Lowest of: NADAC, U&C; if no NADAC, WAC, SMAC, U&C", "ingredient_page": 31, "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf", "history": [ { "date": "2020-12-31", "fee": 10.51, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 10.51, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 10.51, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "AR", "name": "Arkansas", "rank": 26, "standard_fee": 10.5, "lowest_volume_tier_fee": 10.5, "lowest_volume_tier_rate": "Preferred brand and generics", "gap": -1.5, "color": "none", "standard_rate": "Preferred brand and generics", "other_rates": [ { "label": "Brand and non-preferred brand", "fee": 9.0, "unit": "per_rx", "source_url": "https://www.medicaid.gov/sites/default/files/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/AR/AR-16-003.pdf" } ], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "", "ingredient_cost_basis": "Lowest of: NADAC (WAC if no NADAC), state AAC, FUL", "ingredient_page": 2, "source_url": "https://www.medicaid.gov/sites/default/files/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/AR/AR-16-003.pdf", "history": [ { "date": "2017-04-01", "fee": 10.5, "superseded": "no", "source_url": "https://www.medicaid.gov/sites/default/files/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/AR/AR-16-003.pdf" }, { "date": "2020-12-31", "fee": 10.5, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 10.5, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 10.5, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "KS", "name": "Kansas", "rank": 26, "standard_fee": 10.5, "lowest_volume_tier_fee": 10.5, "lowest_volume_tier_rate": "Professional dispensing fee", "gap": -1.5, "color": "none", "standard_rate": "Professional dispensing fee", "other_rates": [], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "", "ingredient_cost_basis": "Lowest of: NADAC, WAC, FUL, SMAC, submitted ingredient cost, U&C", "ingredient_page": 8, "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf", "history": [ { "date": "2020-12-31", "fee": 10.5, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 10.5, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 10.5, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "SC", "name": "South Carolina", "rank": 26, "standard_fee": 10.5, "lowest_volume_tier_fee": 10.5, "lowest_volume_tier_rate": "Professional dispensing fee", "gap": -1.5, "color": "none", "standard_rate": "Professional dispensing fee", "other_rates": [], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "", "ingredient_cost_basis": "Lowest of: NADAC (if none, WAC minus 0%), SMAC, U&C", "ingredient_page": 23, "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf", "history": [ { "date": "2020-12-31", "fee": 10.5, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 10.5, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 10.5, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "SD", "name": "South Dakota", "rank": 26, "standard_fee": 10.5, "lowest_volume_tier_fee": 10.5, "lowest_volume_tier_rate": "Professional dispensing fee", "gap": -1.5, "color": "none", "standard_rate": "Professional dispensing fee", "other_rates": [], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "", "ingredient_cost_basis": "U&C, SMAC, NADAC, or WAC", "ingredient_page": 23, "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf", "history": [ { "date": "2020-12-31", "fee": 10.5, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 10.5, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 10.5, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "WV", "name": "West Virginia", "rank": 30, "standard_fee": 10.49, "lowest_volume_tier_fee": 10.49, "lowest_volume_tier_rate": "Professional dispensing fee", "gap": -1.51, "color": "none", "standard_rate": "Professional dispensing fee", "other_rates": [], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "", "ingredient_cost_basis": "Lowest of: NADAC (if none, WAC plus 0%), FUL, SMAC, submitted ingredient cost, U&C", "ingredient_page": 30, "source_url": "https://bms.wv.gov/wv-medicaid-pharmacy-pricing-methodology-changes", "history": [ { "date": "2017-06-21", "fee": 10.49, "superseded": "no", "source_url": "https://bms.wv.gov/wv-medicaid-pharmacy-pricing-methodology-changes" }, { "date": "2020-12-31", "fee": 10.49, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 10.49, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 10.49, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "IN", "name": "Indiana", "rank": 31, "standard_fee": 10.48, "lowest_volume_tier_fee": 10.48, "lowest_volume_tier_rate": "Professional dispensing fee", "gap": -1.52, "color": "none", "standard_rate": "Professional dispensing fee", "other_rates": [], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "", "ingredient_cost_basis": "Lowest of: NADAC, state MAC, FUL, WAC", "ingredient_page": 7, "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf", "history": [ { "date": "2020-12-31", "fee": 10.48, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 10.48, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 10.48, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "NH", "name": "New Hampshire", "rank": 32, "standard_fee": 10.47, "lowest_volume_tier_fee": 10.47, "lowest_volume_tier_rate": "Professional dispensing fee", "gap": -1.53, "color": "none", "standard_rate": "Professional dispensing fee", "other_rates": [], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "", "ingredient_cost_basis": "Lowest of: NADAC, WAC plus 0%, SMAC, FUL, U&C", "ingredient_page": 17, "source_url": "https://www.medicaid.gov/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/NH/NH-17-0003.pdf", "history": [ { "date": "2017-04-01", "fee": 10.47, "superseded": "no", "source_url": "https://www.medicaid.gov/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/NH/NH-17-0003.pdf" }, { "date": "2020-12-31", "fee": 10.47, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 10.47, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 10.47, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "NM", "name": "New Mexico", "rank": 33, "standard_fee": 10.3, "lowest_volume_tier_fee": 10.3, "lowest_volume_tier_rate": "Professional dispensing fee", "gap": -1.7, "color": "none", "standard_rate": "Professional dispensing fee", "other_rates": [], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "", "ingredient_cost_basis": "Lowest of: FUL, NADAC, WAC, U&C", "ingredient_page": 18, "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf", "history": [ { "date": "2020-12-31", "fee": 10.3, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 10.3, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 10.3, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "FL", "name": "Florida", "rank": 34, "standard_fee": 10.24, "lowest_volume_tier_fee": 10.24, "lowest_volume_tier_rate": "Professional dispensing fee", "gap": -1.76, "color": "none", "standard_rate": "Professional dispensing fee", "other_rates": [], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "", "ingredient_cost_basis": "Lowest of: NADAC, WAC plus 0%, SMAC, U&C", "ingredient_page": 5, "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf", "history": [ { "date": "2020-12-31", "fee": 10.24, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 10.24, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 10.24, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "NC", "name": "North Carolina", "rank": 34, "standard_fee": 10.24, "lowest_volume_tier_fee": 10.24, "lowest_volume_tier_rate": "Professional dispensing fee", "gap": -1.76, "color": "none", "standard_rate": "Professional dispensing fee", "other_rates": [], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-12-01", "to_date": "2026-09-30" }, "changed_since": "2022-12-01", "ingredient_cost_basis": "Lowest of: NADAC, MAC, U&C, GAD", "ingredient_page": 19, "source_url": "https://www.medicaid.gov/medicaid/spa/downloads/NC-22-0033.pdf", "history": [ { "date": "2020-12-31", "fee": 13.0, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 13.0, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2022-12-01", "fee": 10.24, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/spa/downloads/NC-22-0033.pdf" }, { "date": "2026-09-30", "fee": 10.24, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "NY", "name": "New York", "rank": 36, "standard_fee": 10.18, "lowest_volume_tier_fee": 10.18, "lowest_volume_tier_rate": "Professional dispensing fee", "gap": -1.82, "color": "none", "standard_rate": "Professional dispensing fee", "other_rates": [], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "between 2020-12-31 and 2022-09-30", "ingredient_cost_basis": "Lowest of: NADAC, WAC, WAC minus 17.5% (generic), FUL, SMAC, U&C", "ingredient_page": 18, "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf", "history": [ { "date": "2020-12-31", "fee": 10.08, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 10.18, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 10.18, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "NV", "name": "Nevada", "rank": 37, "standard_fee": 10.17, "lowest_volume_tier_fee": 10.17, "lowest_volume_tier_rate": "Professional dispensing fee", "gap": -1.83, "color": "none", "standard_rate": "Professional dispensing fee", "other_rates": [], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2023-12-01", "to_date": "2026-09-30" }, "changed_since": "", "ingredient_cost_basis": "Lowest of: NADAC, FUL, SMAC, U&C", "ingredient_page": 17, "source_url": "https://www.medicaid.gov/medicaid/spa/downloads/NV-23-0014.pdf", "history": [ { "date": "2020-12-31", "fee": 10.17, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 10.17, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2023-12-01", "fee": 10.17, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/spa/downloads/NV-23-0014.pdf" }, { "date": "2026-09-30", "fee": 10.17, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "AZ", "name": "Arizona", "rank": 38, "standard_fee": 10.11, "lowest_volume_tier_fee": 10.11, "lowest_volume_tier_rate": "Covered outpatient drugs", "gap": -1.89, "color": "none", "standard_rate": "Covered outpatient drugs", "other_rates": [ { "label": "Compounded prescriptions", "fee": 15.34, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "", "ingredient_cost_basis": "U&C, AHCCCS MAC, NADAC, or contracted rates with the FFS pharmacy benefit manager", "ingredient_page": 2, "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf", "history": [ { "date": "2020-12-31", "fee": 10.11, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 10.11, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 10.11, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "CA", "name": "California", "rank": 39, "standard_fee": 10.05, "lowest_volume_tier_fee": 13.2, "lowest_volume_tier_rate": "Pharmacies with fewer than 90,000 claims a year", "gap": -1.95, "color": "none", "standard_rate": "Pharmacies with 90,000 claims or more a year", "other_rates": [ { "label": "Pharmacies with fewer than 90,000 claims a year", "fee": 13.2, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "", "ingredient_cost_basis": "Lowest of: NADAC (if none, WAC plus 0%), FUL, MAIC", "ingredient_page": 2, "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf", "history": [ { "date": "2020-12-31", "fee": 10.05, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 10.05, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 10.05, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "MA", "name": "Massachusetts", "rank": 40, "standard_fee": 10.02, "lowest_volume_tier_fee": 10.02, "lowest_volume_tier_rate": "Professional dispensing fee", "gap": -1.98, "color": "none", "standard_rate": "Professional dispensing fee", "other_rates": [], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "", "ingredient_cost_basis": "Lowest of: FUL, WAC, NADAC, U&C", "ingredient_page": 13, "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf", "history": [ { "date": "2020-12-31", "fee": 10.02, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 10.02, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 10.02, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "NE", "name": "Nebraska", "rank": 40, "standard_fee": 10.02, "lowest_volume_tier_fee": 10.02, "lowest_volume_tier_rate": "Professional dispensing fee", "gap": -1.98, "color": "none", "standard_rate": "Professional dispensing fee", "other_rates": [], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "", "ingredient_cost_basis": "Lowest of: NADAC, FUL, MAC, U&C", "ingredient_page": 16, "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf", "history": [ { "date": "2020-12-31", "fee": 10.02, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 10.02, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 10.02, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "DE", "name": "Delaware", "rank": 42, "standard_fee": 10.0, "lowest_volume_tier_fee": 10.0, "lowest_volume_tier_rate": "Professional dispensing fee", "gap": -2.0, "color": "none", "standard_rate": "Professional dispensing fee", "other_rates": [], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "", "ingredient_cost_basis": "NADAC; if none, Delaware MAC; if none, WAC plus 2% (legend); or U&C", "ingredient_page": 4, "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf", "history": [ { "date": "2020-12-31", "fee": 10.0, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 10.0, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 10.0, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "PA", "name": "Pennsylvania", "rank": 42, "standard_fee": 10.0, "lowest_volume_tier_fee": 10.0, "lowest_volume_tier_rate": "Professional dispensing fee", "gap": -2.0, "color": "none", "standard_rate": "Professional dispensing fee", "other_rates": [], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "", "ingredient_cost_basis": "Generics, lowest of: U&C, NADAC (if none, WAC minus 50.5%), FUL, state MAC", "ingredient_page": 22, "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf", "history": [ { "date": "2020-12-31", "fee": 10.0, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 10.0, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 10.0, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "OR", "name": "Oregon", "rank": 44, "standard_fee": 9.99, "lowest_volume_tier_fee": 16.87, "lowest_volume_tier_rate": "Fewer than 40,000 claims a year", "gap": -2.01, "color": "none", "standard_rate": "80,000 or more claims a year", "other_rates": [ { "label": "40,000 to 79,999 claims a year", "fee": 11.93, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid/spa/downloads/OR-24-0019.pdf" }, { "label": "Fewer than 40,000 claims a year", "fee": 16.87, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid/spa/downloads/OR-24-0019.pdf" }, { "label": "340B covered entities", "fee": 20.86, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid/spa/downloads/OR-24-0019.pdf" } ], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2024-11-01", "to_date": "2026-09-30" }, "changed_since": "2024-11-01", "ingredient_cost_basis": "Lowest of: Oregon AAC file, NADAC, WAC plus 0%, U&C", "ingredient_page": 22, "source_url": "https://www.medicaid.gov/medicaid/spa/downloads/OR-24-0019.pdf", "history": [ { "date": "2020-12-31", "fee": 9.8, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 9.8, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2024-11-01", "fee": 9.99, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/spa/downloads/OR-24-0019.pdf" }, { "date": "2026-09-30", "fee": 9.99, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "WA", "name": "Washington", "rank": 45, "standard_fee": 9.8, "lowest_volume_tier_fee": 14.3, "lowest_volume_tier_rate": "Fewer than 30,000 prescriptions a year", "gap": -2.2, "color": "none", "standard_rate": "70,000 or more prescriptions a year", "other_rates": [ { "label": "30,000 to 69,999 prescriptions a year", "fee": 11.91, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid/spa/downloads/WA-23-0050.pdf" }, { "label": "Fewer than 30,000 prescriptions a year", "fee": 14.3, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid/spa/downloads/WA-23-0050.pdf" }, { "label": "Unit dose systems", "fee": 14.3, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2023-07-01", "to_date": "2026-09-30" }, "changed_since": "2023-07-01", "ingredient_cost_basis": "AAC, the lowest of NADAC, MAC, FUL, U&C, submitted ingredient cost; WAC where there is no NADAC", "ingredient_page": 29, "source_url": "https://www.medicaid.gov/medicaid/spa/downloads/WA-23-0050.pdf", "history": [ { "date": "2020-12-31", "fee": 4.24, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 4.24, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2023-07-01", "fee": 9.8, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/spa/downloads/WA-23-0050.pdf" }, { "date": "2026-09-30", "fee": 9.8, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "CO", "name": "Colorado", "rank": 46, "standard_fee": 9.31, "lowest_volume_tier_fee": 13.4, "lowest_volume_tier_rate": "Fewer than 60,000 prescriptions a year", "gap": -2.69, "color": "none", "standard_rate": "More than 110,000 prescriptions a year", "other_rates": [ { "label": "90,000 to 110,000 prescriptions a year", "fee": 10.25, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" }, { "label": "60,000 to 90,000 prescriptions a year", "fee": 11.49, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" }, { "label": "Fewer than 60,000 prescriptions a year", "fee": 13.4, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" }, { "label": "Rural pharmacies", "fee": 14.14, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" }, { "label": "Government pharmacies", "fee": 0.0, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" }, { "label": "Parenteral nutrition products", "fee": 73.21, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "", "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)", "ingredient_page": 3, "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf", "history": [ { "date": "2020-12-31", "fee": 9.31, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 9.31, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 9.31, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "TN", "name": "Tennessee", "rank": 47, "standard_fee": 9.02, "lowest_volume_tier_fee": 13.16, "lowest_volume_tier_rate": "Ambulatory pharmacies under 65,000 claims a year, and long-term care", "gap": -2.98, "color": "none", "standard_rate": "Ambulatory pharmacies with 65,000 or more claims a year", "other_rates": [ { "label": "Ambulatory pharmacies under 65,000 claims a year, and long-term care", "fee": 13.16, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid/spa/downloads/TN-23-0005.pdf" }, { "label": "340B claims", "fee": 16.92, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid/spa/downloads/TN-23-0005.pdf" }, { "label": "Specialty drugs", "fee": 52.46, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" }, { "label": "Blood clotting factors", "fee": 172.69, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" }, { "label": "Pharmacies that fail three cost surveys", "fee": 5.0, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" }, { "label": "Out-of-state pharmacies under 65,000 claims in border areas", "fee": 13.16, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" }, { "label": "All other out-of-state pharmacies", "fee": 9.02, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2023-11-01", "to_date": "2026-09-30" }, "changed_since": "2023-11-01", "ingredient_cost_basis": "Lowest of: FUL, AAAC, NADAC, WAC minus 6% (generics, if no AAAC or NADAC), U&C", "ingredient_page": 24, "source_url": "https://www.medicaid.gov/medicaid/spa/downloads/TN-23-0005.pdf", "history": [ { "date": "2020-12-31", "fee": 8.37, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 8.37, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2023-11-01", "fee": 9.02, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/spa/downloads/TN-23-0005.pdf" }, { "date": "2026-09-30", "fee": 9.02, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "RI", "name": "Rhode Island", "rank": 48, "standard_fee": 8.96, "lowest_volume_tier_fee": 8.96, "lowest_volume_tier_rate": "Members not in long-term care", "gap": -3.04, "color": "none", "standard_rate": "Members not in long-term care", "other_rates": [ { "label": "Members in long-term care", "fee": 7.9, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "", "ingredient_cost_basis": "Lowest of: NADAC, WAC plus 0%, FUL, SMAC, FDB SWD minus 19%, U&C", "ingredient_page": 23, "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf", "history": [ { "date": "2020-12-31", "fee": 8.96, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 8.96, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 8.96, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "IL", "name": "Illinois", "rank": 49, "standard_fee": 8.85, "lowest_volume_tier_fee": 8.85, "lowest_volume_tier_rate": "All pharmacies except critical access pharmacies", "gap": -3.15, "color": "none", "standard_rate": "All pharmacies except critical access pharmacies", "other_rates": [ { "label": "Critical access pharmacies", "fee": 15.55, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" }, { "label": "Hemophilia treatment centers for 340B antihemophilic products", "fee": 207.0, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "", "ingredient_cost_basis": "Multiple source drugs, lowest of: U&C, NADAC, WAC minus 17.5%, FUL, state upper limit", "ingredient_page": 7, "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf", "history": [ { "date": "2020-12-31", "fee": 8.85, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 8.85, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 8.85, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "OH", "name": "Ohio", "rank": 50, "standard_fee": 8.3, "lowest_volume_tier_fee": 15.47, "lowest_volume_tier_rate": "Fewer than 50,000 prescriptions a year", "gap": -3.7, "color": "none", "standard_rate": "100,000 or more prescriptions a year", "other_rates": [ { "label": "75,000 to 99,999 prescriptions a year", "fee": 9.51, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" }, { "label": "50,000 to 74,999 prescriptions a year", "fee": 11.4, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" }, { "label": "Fewer than 50,000 prescriptions a year", "fee": 15.47, "unit": "per_rx", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ], "change": { "dollars": 0.0, "pct": 0.0, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "", "ingredient_cost_basis": "Lower of NADAC and U&C; if no NADAC, lowest of WAC plus 0%, SMAC, U&C", "ingredient_page": 21, "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf", "history": [ { "date": "2020-12-31", "fee": 8.3, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": 8.3, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": 8.3, "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] }, { "state": "TX", "name": "Texas", "rank": 51, "standard_fee": "formula", "lowest_volume_tier_fee": "formula", "lowest_volume_tier_rate": "Formula: ((NADAC + $7.93) / (1 - 1.96%)) - NADAC", "gap": null, "color": "none", "standard_rate": "Formula: ((NADAC + $7.93) / (1 - 1.96%)) - NADAC", "other_rates": [], "change": { "dollars": null, "pct": null, "compared_with": "earlier", "from_date": "2022-09-30", "to_date": "2026-09-30" }, "changed_since": "", "ingredient_cost_basis": "Retail: NADAC; if none, WAC minus 2%", "ingredient_page": 26, "source_url": "https://www.medicaid.gov/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/TX/TX-17-0011.pdf", "history": [ { "date": "2017-04-01", "fee": "formula", "superseded": "no", "source_url": "https://www.medicaid.gov/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/TX/TX-17-0011.pdf" }, { "date": "2020-12-31", "fee": "formula", "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/downloads/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state.pdf" }, { "date": "2022-09-30", "fee": "formula", "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/medicaid-covered-outpatient-prescription-drug-reimbursement-information-state" }, { "date": "2026-09-30", "fee": "formula", "superseded": "no", "source_url": "https://www.medicaid.gov/medicaid-prescription-reimbursement-Quarter-Ending-March-2026.pdf" } ] } ] }