Cost Plus Drug analyses
Draft · State Medicaid dispensing fees · Data as of November 4, 2026

Medicaid dispensing fees, state by state

Each state's Medicaid fee-for-service program pays a pharmacy a professional dispensing fee for each prescription. Across 50 jurisdictions, the standard retail fee has a mean of $10.58 and a median of $10.505, the midpoint of $10.50 and $10.51. The table gives each state's fee and its gap to $12.00, the reference baseline in Erin Albert's analysis. Select a state to see its history, tiers, ingredient cost basis and sources.

$10.58
mean standard retail fee, 50 jurisdictions; lowest-volume tier mean $11.45
$10.505
median standard retail fee, 50 jurisdictions: $10.505, the midpoint of $10.50 and $10.51; lowest-volume tier median $10.65
50
fees in the mean and median: 49 states and DC
13
standard fees that changed since the December 2020 CMS chart

Building on Erin Albert's dispensing fee analysis. Every fee here comes from a state Medicaid source or a CMS chart, checked on November 4, 2026. Each state panel names its sources.

Every state and DC

The standard retail fee is the fee for a generic at a retail pharmacy. Where the fee depends on pharmacy volume, it is the fee for the highest-volume pharmacies. Where the fee depends on the place or the pharmacy type, it is the general retail rate: Alaska, on the road system, non-tribal pharmacy; Georgia, all pharmacies except low-volume independents; Illinois, all pharmacies except critical access pharmacies; Maryland, retail community pharmacy; Missouri, in-state pharmacy, before the reimbursement allowance adjustment; Rhode Island, members not in long-term care. The gap is the fee minus $12.00. The rank uses the standard fee, highest first. Select a column heading to sort, and a state to open its panel.

Green: gap of $0.00 or more (fee $12.00 or more) Yellow: gap from -$1.00 to -$0.01 (fee $11.00 to $11.99) No color: gap more than $1.00 under $12.00, or a formula fee Lowest-volume tier: the fee for the lowest-volume pharmacies where a state sets fees by pharmacy volume; states without volume tiers use the same fee in both columns. Rural, critical access and pharmacy-type rates are in each state's panel. Change since prior source: the fee on the current source minus the fee on the dated source closest to 12 months before it, within 10 to 14 months; if there is none, the last earlier dated source; no prior data only when there is no earlier dated source. The cell gives both dates.
Download CSV with history Download JSON
RankStateStandard retail feeLowest-volume tierGap to $12.00Change since prior sourceChanged sinceSource
1$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, 2025Montana SPA 25-0016
2$12.46$12.46+$0.46+$0.00 (+0.0%)
2025-01-01 to 2026-09-30		no changeNorth Dakota SPA 25-0007
3$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, 2021Missouri SPA 21-0008
4$11.89$11.89-$0.11+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		no changeCMS file, September 2026, p. 10
5$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, 2023Louisiana SPA 23-0024
6$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, 2025Alaska SPA 25-0006
7$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, 2024Utah SPA 24-0017
8$11.55$11.55-$0.45+$1.07 (+10.2%)
2022-09-30 to 2024-10-01		October 1, 2024Minnesota SPA 24-0034
9$11.51$15.11-$0.49+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		no changeCMS file, September 2026, p. 6
10$11.29$11.29-$0.71+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		no changeCMS file, September 2026, p. 14
11$11.15$11.15-$0.85+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		no changeCMS file, September 2026, p. 5
12$11.13$11.13-$0.87+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		no changeVermont SPA 17-0005
13$10.92$10.92-$1.08+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		no changeNew Jersey SPA 17-0002
14$10.87$10.87-$1.13+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		no changeCMS file, September 2026, p. 21
15$10.76$10.76-$1.24+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		no changeCMS file, September 2026, p. 6
16$10.75$10.75-$1.25+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		no changeCMS file, September 2026, p. 4
17$10.67$10.67-$1.33+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		between the December 2020 and September 2022 chartsCMS file, September 2026, p. 12
18$10.65$10.65-$1.35+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		no changeCMS file, September 2026, p. 28
18$10.65$10.65-$1.35+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		no changeCMS file, September 2026, p. 32
20$10.64$10.64-$1.36+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		no changeCMS file, September 2026, p. 1
20$10.64$10.64-$1.36+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		no changeKentucky 907 KAR 23:020
20$10.64$10.64-$1.36+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		no changeCMS file, September 2026, p. 13
23$10.63$10.63-$1.37+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		no changeGeorgia SPA 17-0001
23$10.63$10.63-$1.37+$0.25 (+2.4%)
2022-09-30 to 2024-10-01		October 1, 2024Iowa Medicaid Informational Letter 2630-MC-FFS
25$10.51$15.69-$1.49+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		no changeCMS file, September 2026, p. 31
26$10.50$10.50-$1.50+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		no changeArkansas SPA 16-003
26$10.50$10.50-$1.50+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		no changeCMS file, September 2026, p. 8
26$10.50$10.50-$1.50+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		no changeCMS file, September 2026, p. 23
26$10.50$10.50-$1.50+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		no changeCMS file, September 2026, p. 23
30$10.49$10.49-$1.51+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		no changeWest Virginia BMS notice on pharmacy pricing methodology changes
31$10.48$10.48-$1.52+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		no changeCMS file, September 2026, p. 7
32$10.47$10.47-$1.53+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		no changeNew Hampshire SPA 17-0003
33$10.30$10.30-$1.70+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		no changeCMS file, September 2026, p. 18
34$10.24$10.24-$1.76+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		no changeCMS file, September 2026, p. 5
34$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, 2022North Carolina SPA 22-0033
36$10.18$10.18-$1.82+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		between the December 2020 and September 2022 chartsCMS file, September 2026, p. 18
37$10.17$10.17-$1.83+$0.00 (+0.0%)
2023-12-01 to 2026-09-30		no changeNevada SPA 23-0014
38$10.11$10.11-$1.89+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		no changeCMS file, September 2026, p. 2
39$10.05$13.20-$1.95+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		no changeCMS file, September 2026, p. 2
40$10.02$10.02-$1.98+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		no changeCMS file, September 2026, p. 13
40$10.02$10.02-$1.98+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		no changeCMS file, September 2026, p. 16
42$10.00$10.00-$2.00+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		no changeCMS file, September 2026, p. 4
42$10.00$10.00-$2.00+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		no changeCMS file, September 2026, p. 22
44$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, 2024Oregon SPA 24-0019
45$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, 2023Washington SPA 23-0050
46$9.31$13.40-$2.69+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		no changeCMS file, September 2026, p. 3
47$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, 2023Tennessee SPA 23-0005
48$8.96$8.96-$3.04+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		no changeCMS file, September 2026, p. 23
49$8.85$8.85-$3.15+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		no changeCMS file, September 2026, p. 7
50$8.30$15.47-$3.70+$0.00 (+0.0%)
2022-09-30 to 2026-09-30		no changeCMS file, September 2026, p. 21
51formulaformulanot computedformula, no change computed
2022-09-30 to 2026-09-30		no changeTexas SPA 17-0011

Texas is not in the mean or the median, because its fee is a formula: "((Acquisition Cost + Fixed Component) divided by (1 minus the percentage used to calculate the Variable Component)) minus Acquisition Cost", with a fixed component of $7.93 and a variable component of 1.96% (Texas SPA 17-0011). The table ranks it by the formula at an ingredient cost of $0, $8.09.

Change since prior source: 0 states have a dated source 10 to 14 months before the current one, 51 are compared with an older dated source, and 0 have no earlier dated source. We found no CMS chart edition dated 2023 to 2025. Where the comparison starts on the day a state source changed the fee, the cell says so: 9 states.

Missouri also adds an adjustment for its pharmacy reimbursement allowance, and long-term care pharmacies get $0.50 more. North Dakota adds $0.15 per pill for pill splitting. The table shows the fee before these.

Ingredient cost basis, in each panel: what the state pays for the drug itself, for a generic at a retail pharmacy, from the CMS file's Ingredient Cost column or the state plan. Abbreviations: AAC, actual acquisition cost; AAAC, average actual acquisition cost; FUL, federal upper limit; GAD, generic average dispensing cost; MAC, maximum allowable cost; MAIC, maximum allowable ingredient cost; SMAC, state maximum allowable cost; SWP and SWD, a supplier's wholesale price; U&C, the pharmacy's usual and customary charge; WAC, wholesale acquisition cost; AWP, average wholesale price.

Which CMS chart

The live CMS chart page, Medicaid Covered Outpatient Prescription Drug Reimbursement Information by State, shows the table for the quarter ending September 2022. The page says it was last updated on November 16, 2022. It is an HTML table, and it links no chart file.

A newer CMS file exists at a different medicaid.gov address: a PDF titled Quarter Ending September 2026. The file name says March 2026, but the title inside says September 2026, and the file was created on October 19, 2026. The chart page does not link it. This page uses it as the CMS source for 30 jurisdictions, and every fee in it was checked against the rendered pages.

The December 2020 chart is an older CMS PDF at a medicaid.gov downloads address, titled Quarter Ending December 2020 and created February 23, 2021. It gives the first point of each state's history.

Method and sources

  • The fees come from the shared dataset data/state-dispensing-fees: 106 rates and 176 dated points, each with a source and the date checked, 2026-11-04. Each value is found in its own source copy.
  • A state source wins over a CMS chart when they disagree, because the chart lags the state.
  • The mean and median use the 50 flat standard fees: 49 states and DC. Puerto Rico is in the dataset but not on this page.
  • The page holds every row and panel. The script on the page only sorts, filters and opens them. It loads nothing from the web.

Receipts

Each row names a source on this page and the copy kept with the page.

Used forSourceCopy kept with this page
Fees or history: AKAlaska SPA 25-0006 (effective July 1 2025)spa-AK-25-0006.pdf
Fees or history: ARArkansas SPA 16-003 (effective April 1 2017)spa-AR-16-003.pdf
Fee history, December 2020CMS reimbursement information by state, PDF titled Quarter Ending December 2020cms-reimbursement-chart-qe-dec-2020.pdf
Fee history, September 2022; the live chart pageCMS chart page, Quarter Ending September 2022 (page last updated November 16, 2022)cms-chart-page-qe-sep-2022.html
Fees, tiers and ingredient cost basis; fee history, September 2026CMS reimbursement information by state, PDF titled Quarter Ending September 2026
CMS file name says March 2026; the document is titled Quarter Ending September 2026.		cms-reimbursement-chart-qe-sep-2026.pdf
Fees or history: GAGeorgia SPA 17-0001 (effective April 1 2017)spa-GA-17-0001.pdf
Fees or history: IAIowa Medicaid Informational Letter 2630-MC-FFS (effective October 1 2024)ia-informational-letter-2630.pdf
Fees or history: KYKentucky 907 KAR 23:020 (fee effective April 1 2017)ky-907-kar-23-020-2026-11-04.html
Fees or history: LALouisiana SPA 23-0024 (effective October 1 2023)spa-LA-23-0024.pdf
Fees or history: MNMinnesota SPA 24-0034 (effective October 1 2024)spa-MN-24-0034.pdf
Fees or history: MOMissouri SPA 21-0008 (effective February 1 2021)spa-MO-21-0008.pdf
Fees or history: MTMontana SPA 25-0016 (effective July 1 2025)spa-MT-25-0016.pdf
Fees or history: NCNorth Carolina SPA 22-0033 (effective December 1 2022)spa-NC-22-0033.pdf
Fees or history: NDNorth Dakota SPA 19-0004 (effective July 1 2019)spa-ND-19-0004.pdf
Fees or history: NDNorth Dakota SPA 25-0007 (effective January 1 2025)spa-ND-25-0007.pdf
Fees or history: NHNew Hampshire SPA 17-0003 (effective April 1 2017)spa-NH-17-0003.pdf
Fees or history: NJNew Jersey SPA 17-0002 (effective April 1 2017)spa-NJ-17-0002.pdf
Fees or history: NVNevada SPA 23-0014 (effective December 1 2023)spa-NV-23-0014.pdf
Fees or history: OROregon SPA 24-0019 (effective November 1 2024)spa-OR-24-0019.pdf
Fees or history: TNTennessee SPA 23-0005 (effective November 1 2023)spa-TN-23-0005.pdf
Fees or history: TXTexas SPA 17-0011 (effective April 1 2017)spa-TX-17-0011.pdf
Fees or history: UTUtah SPA 24-0017 (effective July 15 2024)spa-UT-24-0017.pdf
Fees or history: VTVermont SPA 17-0005 (effective April 1 2017)spa-VT-17-0005.pdf
Fees or history: WAWashington SPA 23-0050 (effective July 1 2023)spa-WA-23-0050.pdf
Fees or history: WVWest Virginia BMS notice on pharmacy pricing methodology changes (fee effective June 21 2017)wv-bms-pricing-methodology-2026-11-04.html
CreditErin Albert, dispensing fee analysisLink only