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Benefits by Service: Prescription Drugs (October 2006) Definition/Notes
 
 
 
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Note: Totals include 50 states and D.C. "Benefits Covered" Totals "Benefits Not Covered" Totals
Is the benefit covered? 51 0
          Is there a co-payment requirement?
Yes: 42 No: 9




Alabama
Yes $.50-$3/Rx depending on drug cost 4 brand Rxs/month except brand antipsychotics and antiretrovirals up to 10 Rxs/month Lower of AWP-10% or WAC+9.2%, plus $5.40 dispensing fee CN
Alaska
Yes $2/Rx Specified drugs AWP-5%, plus a dispensing fee dependent on Medicaid volume ($3.45 to $11.46) CN
Arizona
Yes AWP-15%, plus $2.00 dispensing fee CN & MN
Arkansas
Yes $.50-$3/Rx depending on drug cost More than 3 prescriptions per month for non-institutionalized beneficiaries 6 Rxs/month except for persons in nursing facilities or participating in HCBS waivers AWP-14% for brand Rx, AWP-20% for generic Rx, plus $5.51 dispensing fee for each, additional $2.00 dispensing fee for generic Rx with no FUL or state MAC CN & MN
California
Yes $1/Rx 6 Rxs/month AWP-17%, plus $7.25 dispensing fee, non-traditional pharmacies receive an $8.00 dispensing fee CN & MN
Colorado
Yes $1/generic or multi-source Rx, $3/brand or single source Rx Over the counter drugs other than insulin and aspirin, compounded Rxs 8 Rxs/month AWP-13.5% for brand Rx, AWP-35% for generic Rx, plus $4.00 dispensing fee for each, non-traditional pharmacies receive a $1.89 dispensing fee CN
Connecticut
Yes Vitamins, nutritional supplements, other specified drugs including amphetamines 30 day supply for acute conditions, 30 day supply or 240 dosage units for chronic conditions, AWP-14% for brand Rx, AWP-40% for generic Rx, plus $3.15 dispensing fee CN & MN
Delaware
Yes $.50-$3/Rx depending on drug cost, up to $15/month Rx must be generic unless DAW AWP-14% by retail pharmacies, AWP-16% by non-traditional pharmacies, plus $3.65 dispensing fee for each CN
District of Columbia
Yes $1/Rx Specified drugs and injectables including Percodan and Dalmane AWP-10%, plus $4.50 dispensing fee CN & MN
Florida
Yes Specified drugs Step therapy required for some drugs not on PDL Lower of AWP-15.4% or WAC+5.75%, plus $4.23 dispensing fee for retail pharmacies or $4.73 dispensing fee for non-traditional pharmacies CN & MN
Georgia
Yes $.50-$3/Rx depending on drug cost and status Specified drugs 5 Rxs or refills/month AWP-11%, plus $4.69 dispensing fee to for profit retail pharmacies, dispensing fee $.33 less to non-profit pharmacies CN & MN
Hawaii
Yes Specified drugs AWP-10.5%, plus $4.67 dispensing fee CN & MN
Idaho
Yes Specified drugs including amphetamines, high cost and therapeutic-equivalent drugs AWP-12%, plus $4.94 dispensing fee, $5.54 dispensing fee if unit dose CN
Illinois
Yes $3/brand Rx, $1/generic Rx 3 brand Rx/month AWP-12%, plus $3.40 dispensing fee for brand Rx, AWP-25%, plus $4.60 dispensing fee for generic Rx CN & MN
Indiana
Yes $3/Rx Specified drugs AWP-16% for brand Rx, AWP-20% for generic Rx, plus $4.90 dispensing fee for each CN
Iowa
Yes $1/generic and preferred brand Rx, $2-$3/non-preferred brand Rx depending on payment Specified drugs AWP-12%, plus $4.26 dispensing fee CN & MN
Kansas
Yes $3/Rx Specified drugs Adult vitamins limited to pregnancy supplements AWP-13% for brand Rx, AWP-27% for generic Rx, plus $3.40 dispensing fee for each CN & MN
Kentucky
Yes $1/generic Rx; $2/preferred brand Rx; B - $3/non-preferred brand Rx; A, C & D - 5% of payment up to $20 for non-preferred brand Rx; A, B, C & D - annual out-of-pocket expense capped at $225 Specified drugs, including amphetamines and over the counter products A, C & D - 4 Rx/month including up to 3 brand Rx AWP-15% for brand Rx plus $4.50 dispensing fee; AWP-14% for generic Rx plus $5.00 dispensing fee A, B, C & D - See state-specific FN
Louisiana
Yes $.50-$3/Rx depending on drug cost Specified drugs 8 Rxs/month AWP-13.5% for independent pharmacies, AWP-15% for chain stores, plus $5.77 dispensing fee for each CN & MN
Maine
Yes $2.50/Rx, up to $25/month, no copayment required for mail order Rxs Non-preferred drugs 5 brand Rxs/month for residents in supervised settings AWP-15% for brand Rx , AWP-13% for generic Rx, AWP-17% for direct supply drugs, plus $3.35 dispensing fee for each; AWP-60% for generic Rx and AWP-20% for brand Rx through mail order pharmacy, plus $1.00 dispensing fee for each CN & MN
Maryland
Yes $1/Rx for generic or preferred brand, $3/Rx for non-preferred brand Specified antibiotic liquids, some nutritional supplements Specified quantity limits for selected drugs Lower of AWP-12% or WAC+8% or direct price +8%, plus $2.69 dispensing fee for generic or preferred brand Rx by traditional pharmacies or $3.69 dispensing fee for generic or preferred brand Rx by non-traditional pharmacies, dispensing fees $1.00 less for non-preferred brand Rx CN & MN
Massachusetts
Yes $1/generic Rx or OTC product, $3/brand Rx Specified drugs WAC+5% plus $3.00 dispensing fee; 340B pharmacies paid drug cost plus $3.00 dispensing fee CN & MN
Michigan
Yes $1/generic Rx, $3/brand Rx AWP-13.5% for independent pharmacies, AWP-15.1% for chain stores, plus $2.50 dispensing fee for each, non-traditional pharmacies paid $2.75 dispensing fee CN & MN
Minnesota
Yes A - $1/generic Rx, $3/brand Rx, up to $12/month, antipsychotic Rxs not subject to copayments; B - $3/Rx with no cap and no exceptions - See state-specific FN Non-preferred and brand Rx when generic available AWP-12%, plus $3.65 dispensing fee; specialty drug products paid less - See state-specific FN A & B - See state-specific FN
Mississippi
Yes $3/Rx Specified drugs 5 Rxs/month including 2 brand Rxs, limit not applicable to beneficiaries in nursing facilities AWP-12% or WAC+9% for brand Rx plus $3.91 dispensing fee; AWP-25% for generic Rx plus $4.91 dispensing fee; non-traditional pharmacies paid $3.91 dispensing fee CN
Missouri
Yes $.50-$2/Rx depending on drug cost Lower of AWP-10.43% or WAC+10%, plus $4.09 dispensing fee CN & MN
Montana
Yes $1-$5/Rx depending on drug cost, up to $25 max per month Specified drugs AWP-15%, plus cost based dispensing fee between $2 and $4.70 A & B - See state-specific FN
Nebraska
Yes $2/Rx Specified drugs 90 day supply AWP-11%, plus pharmacy specific dispensing fee of $3.27-$5.00 CN & MN
Nevada
Yes $1/generic Rx, $2/brand Rx Specified drugs AWP-15%, plus $4.76 dispensing fee CN
New Hampshire
Yes $1/generic Rx, $2/brand or compound Rx Specified drugs 30 day minimum supply up to 90 day maximum supply AWP-16%, plus $1.75 dispensing fee CN & MN
New Jersey
Yes Specified drugs including nutritional supplements and methadone AWP-12.5%, plus pharmacy specific dispensing fee of $3.73-$4.07 depending on services provided, non-traditional pharmacies receive a capitated dispensing fee CN & MN - See state-specific FN
New Mexico
Yes A - $3/Rx up to $12/month, B - $5/Rx - see state-specific FN Rx must be generic unless DAW, mail order dispensing permitted AWP-14%, plus $3.65 dispensing fee CN
New York
Yes $.50/generic Rx and over the counter product, $2/brand Rx Specified drugs 40 Rxs/year AWP-13.25% for brand Rx, AWP-20% for generic Rx, plus $3.50 dispensing fee for brand Rx or $4.50 dispensing fee for generic Rx, specialized HIV pharmacies paid AWP-12% CN & MN
North Carolina
Yes $3/Rx Specified high cost drugs 8 Rxs/month, pharmacist may override for 3 additional if necessary AWP-10%, plus $5.60 dispensing fee for generic Rx or OTC products; AWP-10%, plus $4.00 dispensing fee for brand Rx CN & MN
North Dakota
Yes $3/brand Rx Adult vitamins limited to pregnancy supplements, smoking cessation products limited AWP-10% or WAC+12.5%, plus $4.60 dispensing fee for brand Rx and $5.60 for generic Rx CN & MN
Ohio
Yes $2/selected brand Rx, $3/Rx if not on Preferred Drug List Specified drugs WAC+7% (or AWP-14.4% if WAC unknown), plus $3.70 dispensing fee for non-compounded Rx CN
Oklahoma
Yes $1-$2/Rx, depending on drug cost 6 Rxs/month including 3 brand Rxs, 7 additional generic Rxs/month for home and community based waiver participants AWP-12%, plus $4.15 dispensing fee CN
Oregon
Yes A - $2/generic Rx, $3/brand Rx Specified drugs including nutritional supplements, growth hormones and anti-ulcer drugs 15 Rxs/month, 100 day supply AWP-15%, plus $3.50 dispensing fee for traditional pharmacies, AWP-11%, plus $3.91 dispensing fee for non-traditional pharmacies A & B - See state-specific FN
Pennsylvania
Yes $1/generic Rx, $3/brand Rx MN - limited to birth control drugs but long term care residents have no limitations WAC+7% for brand Rx or WAC+66% for generic, plus $4.00 dispensing fee CN & MN
Rhode Island
Yes Specified drugs and injectables WAC, plus $3.40 dispensing fee for traditional pharmacies and $2.85 dispensing fee for non-traditional pharmacies CN & MN - see state-specific FN
South Carolina
Yes $3/Rx 4 Rxs/month AWP-10%, plus $4.05 dispensing fee for traditional pharmacies and $3.15 dispensing fee for non-traditional pharmacies CN
South Dakota
Yes $3/brand Rx Specified over the counter products Adult vitamins limited to pregnancy supplements, over the counter products not covered except insulin AWP-10.5%, plus $4.75 dispensing fee for traditional pharmacies and $5.55 dispensing fee for non-traditional pharmacies CN
Tennessee
Yes $3/brand Rx 5 Rxs/month including up to 2 brand Rx, specified additional drugs covered outside limit, OTCs not covered except for prenatal vitamins, barbiturates and benzodiazepines not covered A - See state-specific FN
Texas
Yes 3 Rxs/month Lower of AWP-15% or WAC+12% for independent pharmacies, AWP-18% for chain stores, plus $5.14 dispensing fee CN & MN
Utah
Yes A - $3/Rx up to $15/month, B - $3/Rx, C - $5/generic or preferred brand Rx and 25% cost for others, B & C - full payment for brand when generic available A & B - 7 Rxs/month, C - 4 Rxs/month, A & B - limited over the counter products covered, C - over the counter products not covered AWP-15%, plus $3.90 dispensing fee for urban pharmacies or $4.40 dispensing fee for rural pharmacies A, B & C - See state-specific FN
Vermont
Yes A - $1-$3 depending on drug cost Specified drugs A & B - Rxs for chronic conditions must be at least 30 day supply, adult vitamins limited to pregnancy supplements, lowest price generic equivalent product must be dispensed AWP-11.9%, plus $4.75 dispensing fee for in-state pharmacies A & B - See state-specific FN
Virginia
Yes $1/generic Rx, $3/brand Rx Specified drugs Rx must be generic unless DAW AWP-10.25%, plus $4.00 dispensing fee to traditional pharmacies or $5.00 per month dispensing fee to non-traditional pharmacies CN & MN
Washington
Yes Specified drugs AWP-14% to traditional pharmacies or AWP-19% to mail order contractors for drugs available from fewer than 5 labelers or manufacturers, AWP-50% to traditional pharmacies or AWP-15% to mail order contractors for multi-source drugs, plus a dispensing fee to traditional pharmacies dependent on Medicaid volume (low and unit dose: $5.25, med: $4.56, high: $4.24), $3.25 dispensing fee to mail order contractors CN & MN
West Virginia
Yes $.50-$3/Rx depending on drug cost Specified drugs including vitamins, acute dosing of anti-ulcer drugs beyond 90 days and amphetamines 10 Rxs/month, specified over the counter products covered AWP-30%, plus $5.30 dispensing fee for generic Rx; AWP-15%, plus $2.50 dispensing fee for brand Rx; $1.00 more for compound Rxs CN & MN
Wisconsin
Yes $3/Rx up to $5/month, $.50/over the counter drug Specified drugs, including antibiotics costing more than $100/day and nutritional supplements Most drugs limited to 34 day supply with 100 day supply for some AWP-16%, plus $3.88 dispensing fee CN & MN
Wyoming
Yes $1/generic or preferred brand Rx, $3/non-preferred brand Rx Non-preferred brand drugs, obesity products, over the counter drugs AWP-11%, plus $5.00 dispensing fee CN
American Samoa
Yes Prospective payment/Rx based on prior year cost See territory-specific FN
Guam
Yes Adult vitamins limited to pregnancy supplements AWP, plus $4.40 dispensing fee CN
Northern Mariana Islands
Yes Non-preferred drugs 30 day supply CN & MN - See territory-specific FN
Puerto Rico
Yes Specified high cost drugs and drugs not in plan formulary Maintenance drugs limited to 30 day supply AWP minus agreed upon discount and dispensing fees CN & MN
Virgin Islands
Yes Rxs must be dispensed by public health operated or contracted pharmacies Acquisition cost plus dispensing fee CN



Definition/Notes: Link to Prescription Drugs Footnote

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