An update on Medicaid reimbursement by state

February 5, 2001

Table on Medicaid dispensing fees by state

 

MANAGED CARE

An update on Medicaid reimbursement by state

How does your state Medicaid dispensing fee stack up against that of other states? The following table provides a rundown. Some states did not submit their 2000 information, so their 1999 data are listed.

 

StateDispensing feesIngredient reimbursement basisCo-payYear

Alabama$5.40AWP-10%; WAC+9.2%$0.50 - $3.002000
Alaska$3.45AWP-5%$2.002000
Arizona*AWP-10%1999
Arkansas$5.51AWP-10.5%$0.50 - $3.002000
California$4.05AWP-5%G: $1.00, B: $1.002000
Colorado$4.08AWP-10% or WAC+18% (whichever is lowest)G: $0.50, B: $2.002000
Connecticut$4.10AWP-12%No2000
Delaware$3.65AWP-12.9%No2000
District of Columbia$3.75AWP-10%$1.001999
Florida$4.23AWP-13.25%No2000
Georgia$4.63AWP-10%$0.502000
Hawaii$4.67AWP-10.5%No2000
Idaho$4.94 ($5.54 for unit dose)AWP-11%No2000
IllinoisG: $3.75, B: $3.45AWP-10%, AWP-12% (for multisource drugs)No2000
Indiana$4.00AWP-10%$0.50 - $3.002000
Iowa$4.13 - $6.42AWP-10%$1.002000
Kansas$4.50AWP-10%$2.002000
KentuckyOP: $4.75, LTC: $5.75AWP-10%No2000
Louisiana$5.77AWP-10.5%$0.50 - $3.001999
Maine$3.35 (+ extra fees for compounding)AWP-10%$0.50 - $3.001999
Maryland$4.21Lowest of :WAC + 10%, direct + 10%, AWP -10%$1.002000
Massachusetts$3.00WAC+10%$0.502000
Michigan$3.72AWP-13.5% (1 to 4 stores), $1.00 AWP-15.1% (5+ stores)$1.002000
Minnesota$3.65AWP-9%No2000
Mississippi$4.91AWP-10%$1.002000
Missouri$4.09AWP-10.43%$0.50 - $2.002000
Montana$2.00 - $4.20AWP-10%G: $1.00, B: $2.002000
Nebraska$3.20 - $5.05AWP-8.71%$1.002000
Nevada$4.76AWP-10%No2000
New Hampshire$2.50AWP-12%G: $0.50, B: $1.002000
New Jersey$3.73 - $4.07AWP-10%No2000
New Mexico$4.00AWP-12.5%No1999
New YorkB: $3.50 G: $4.50AWP-10%G: $0.50, B: $2.002000
North Carolina$5.60AWP-10%$1.002000
North Dakota$4.60AWP-10%No1999
Ohio$3.70AWP-11%No2000
Oklahoma$4.15AWP-10.5%$1.00 - $2.002000
Oregon$3.91-$4.28 (based on annual # of Rxs)AWP-11%No2000
Pennsylvania$4.00AWP-10%$1.00 - $2.002000
Rhode IslandOP: $3.40, LTC: $2.85WAC+5%No1999
South Carolina$4.05AWP-10%$2.002000
South Dakota$4.75 ($5.55 for unit dose)AWP-10.5%$2.002000
Tennessee*1999
Texas$5.27 + 2% (of ingredient & dispensing fee)AWP-15% or WAC+12% (whichever is lowest)No2000
Utah$3.90 - $4.40 (based on geographic area)AWP-12%$1.00 - $5.001999
Vermont$4.25AWP-11.9%$1.00 - $2.002000
Virginia$4.25AWP-9%$1.001999
Washington$4.06 - $5.02 (based on annual # of Rxs)AWP-11%No2000
West Virginia$3.90 (+ extra fees for compounding)AWP-12%$0.50 - $2.002000
Wisconsin$4.88AWP-10%$0.50 - $1.002000
Wyoming$4.70AWP-4%$2.002000

 

An update on Medicaid reimbursement by state. Drug Topics 2001;3:79.