Pharmacy dispensing fee: Medicaid rates by state

This is a service-level benchmark rather than a single code: each state's headline rate for pharmacy dispensing fee is chosen to match the same service and the same provider level.

• Provider level. States are compared at the physician or licensed psychologist (incl. BCBA-D) level. Rates for other levels on file (any qualified provider and independent (non-agency) provider) are kept separate, never mixed into this ranking.
• Unit. Of the 13 states, 6 publish their headline rate per prescription and 1 per percent, and 6 schedules print no unit at all (a flat amount per service). The ranking uses the rate as published, so read the unit before comparing two states.
• Variants. 8 of the 13 states publish more than one rate for this service (by modifier, program, setting or provider type); the headline rate is the one that matches the comparison, and the workspace lists every variant.
• Depth. 87 rates for this service are on file across all states, versions and provider levels; this page shows one headline rate per state.

The highest-paying state, District of Columbia, pays $26.40; the lowest, Virginia, pays $1.80, a 14.7x gap. 13 of the 13 states pay above the median of —. Common reasons rates for pharmacy services spread this way:

• Drugs given in a practice or clinic are commonly priced from a benchmark such as average sales price or wholesale acquisition cost, which moves every quarter.
• For children, many vaccines are supplied through the federal Vaccines for Children program, so the Medicaid payment can be for administration only.
• States differ in whether they pay a fixed fee, a percentage of a benchmark or invoice cost.

Billing notes

Drug codes are billed in units of the dose stated in the code, so a larger dose bills more units. Many states require the National Drug Code (NDC) on the claim alongside the billing code.