What Medicaid pays a pharmacy to fill a generic

New Jersey pays for almost all Medicaid prescriptions through managed care plans. In 2025, 99.3% of its fills of the 52 drugs on this page were in managed care: 4,367,646 fills. The plans paid pharmacies $4.57 a fill on average, in total, including the dispensing fee. The figure is the SDUD field Total Amount Reimbursed, which CMS defines as inclusive of dispensing fees. For the same drugs and the same number of tablets, Cost Plus charges $11.06 delivered. New Jersey managed care paid 0.41 times the Cost Plus price.

In fee-for-service, New Jersey pays the pharmacy the drug cost plus a professional dispensing fee of $10.92 a fill (CMS state reimbursement chart, quarter ending September 2026; New Jersey State Plan Amendment 17-0002). That fee alone is 2.4 times what managed care paid in total per fill. A single fee-for-service fill can be paid less than the fee: New Jersey pays no more than the pharmacy's usual and customary charge for the drug and the fee together (N.J.A.C. 10:51-1.5).

Fee-for-service had 32,038 fills of these drugs, too few for the state medians, at $10.47 a fill.

This is Medicaid. It is not the State Health Benefits Program for state employees that Analysis 006 covers.

In fee-for-service, the state pays the pharmacy itself. Under a 2016 federal rule, states pay the drug's actual acquisition cost plus a professional dispensing fee (CMS-2345-FC). That is a cost-plus formula. In the 33 states with complete fee-for-service data, the median state paid $11.83 a fill, 1.03 times the Cost Plus price for the same fills. Half the states fall between 0.97 and 1.15 times.

In managed care, the plan, usually through a pharmacy benefit manager, sets what the pharmacy gets. In the 32 states with complete managed-care data, the median state's plans paid $7.02 a fill, 0.62 times the Cost Plus price. Half the states fall between 0.49 and 0.85 times. In 28 of the 32, the pharmacy got less per fill than Cost Plus charges for the same tablets with shipping. The medians leave out the District of Columbia and Puerto Rico, which are in the table.

Kentucky and Ohio each chose one pharmacy benefit manager for all their managed care plans: Kentucky from July 1, 2021, and Ohio from October 1, 2022. In 2025, managed care in Kentucky paid $10.82 a fill and in Ohio $11.02. Their fee-for-service programs paid $10.65 and $10.74.

Paid per fill is the program's total payment to pharmacies for the 52 drugs, divided by its fills. The Cost Plus column is what Cost Plus charges for the same drugs and the same number of tablets. Ratio is the payment divided by the Cost Plus amount. New Jersey is first. The medians use only states with complete data. Below 20,000 fills, the table shows the fills only.

Complete means the program reported at least 45 of the 52 drugs and at least 100,000 fills of them in 2025. Partial programs show in the table but not in the medians.

Not comparable means a program, partial or complete, paid 15 times NADAC or more per tablet across these drugs, which is not a retail fill price. The table shows its fills but no price per fill. Fee-for-service: AZ, MN, NM, SD, WA. Managed care: CA, ND. Several states pay tribal and Indian Health Service pharmacies the federal encounter rate per prescription (TSGAC brief, June 16, 2025; Washington SPA 24-0005). California moved pharmacy out of managed care in 2022, so its remaining managed-care rows are a small, different set. We did not confirm the cause for each state. In other states, a share of encounter-rate claims can raise the fee-for-service average a little.

The policy notes link to each state's own notice. A note states a fact about the program. It does not explain a figure.

Each drug in all complete states together, by program, and in New Jersey managed care. The Cost Plus price for 30 tablets was checked on costplusdrugs.com on October 22, 2026. The same-fills price uses each program's own average fill size, so the two columns price the same tablets.

The amounts are before rebates. Under federal law, makers of generic drugs pay Medicaid a rebate of at least 13% of the average manufacturer price, plus an inflation rebate (Social Security Act, section 1927(c)(3)). States can negotiate supplemental rebates. The amounts also leave out what members paid at the counter.

In managed care, the amount is what the plan paid the pharmacy, as the state reported it (CMS field descriptions). It is not what the state paid the plan, and it does not show what the plan paid its pharmacy benefit manager. Any difference between those amounts is not in this data.

The data has known limits. In testimony to the Ohio Joint Medicaid Oversight Committee on June 26, 2025, Antonio Ciaccia of 46brooklyn Research said Ohio Medicaid had told that committee in 2021 that state drug pricing data was likely not reliable. He cites a Columbus Dispatch report, and the concern was the net drug costs reported to states, not pharmacy pay. CMS blanks every row with fewer than 11 prescriptions: 109,447 suppressed rows for these drugs in 2025 (one row per NDC, state, program and quarter).

Cost Plus is a cash pharmacy. This page does not say that a Medicaid member can fill a prescription there, or that a state could buy these fills at the Cost Plus price. It does not grade any state, plan or pharmacy.

Analysis 005 found 394 counties with exactly one pharmacy left. This page does not show why any pharmacy opens or closes.

• State Drug Utilization Data 2025, all four quarters, updated July 2026: total amount reimbursed, units and prescriptions by NDC, state and program.
• NADAC 2025: the description of each NDC (drug, strength, form) and its generic flag. The drug key is the NADAC description. Kept: generic, prescription-only tablets and capsules priced per tablet.
• The drugs: the 60 generic tablets and capsules with the most Medicaid fills in 2025. Cost Plus lists 52 of them. The other 8 are gabapentin (3 strengths), hydrocodone with acetaminophen, buprenorphine with naloxone, oxycodone, buspirone 10 mg and folic acid 1 mg. Each match was checked by hand.
• Cost Plus prices: the 30-tablet price for each product, checked on costplusdrugs.com on October 22, 2026. The price for q tablets follows the published formula: drug cost times 1.15 times q, plus the $5 pharmacy fee. Shipping is $5.
• State notices for Kentucky, Ohio, California and New York are linked in the state table.
• Earlier work: 46brooklyn Research mapped Medicaid generic markups across states from this same data (Medicaid Markup Galaxies, Markup Universe). Studies of managed-care pharmacy pay and PBM spread in one state each: the Ohio Auditor of State (2018), the Kentucky Cabinet for Health and Family Services (2019), and 3 Axis Advisors (New York, 2019). This page adds 2025 data, per fill, fee-for-service and managed care side by side, against a cash cost-plus benchmark.