340B Medicaid Profiles by State/Territory
Searchable state-by-state Medicaid 340B requirements
Searchable state-by-state Medicaid 340B requirements
Medicaid
This resource has been created by the 340B Prime Vendor Program to assist stakeholders by combining the most recently available 340B-specific Medicaid data with publicly available federal data. Please note that additional requirements or contractual obligations that may be in place from third-party payers are not included in this resource.
Upon selecting a state in the drop-down menu, the Medicaid State Technical, Rebate and Policy contacts and details on the state’s retail prescriptions, provider- or facility-administered drugs, contract pharmacies and Medicaid Managed Care profiles will populate below. Each field is linked to the sourced data where additional information can be found.
Please note: The data presented on this page are compiled from various sources; however, the information is not endorsed by HRSA and not dispositive with the 340B Drug Pricing Program. 340B stakeholders are ultimately responsible for 340B Program compliance and compliance with all applicable state and federal laws and regulations. Stakeholders are encouraged to contact the states to verify current policy/requirements.
State Medicaid agencies do not report 340B profiles to a central database. We appreciate assistance from the 340B community to report any inaccuracies or provide missing information. Please contact us via email or through Apexus Answers.
Technical contact
CHANGE HEALTHCARE
dani rullo
DRULLO@CHANGEHEALTHCARE.COM45 commerce drive suite 5
augusta, ME 04332
(207) 622-7153
Rebate contact
brittany starr
C-BSTARR@PA.GOV303 walnut street 9th floor commonwealth tower
harrisburg, PA 17101
(717) 346-8164
Policy contact
terri cathers
C-TCATHERS@PA.GOV303 walnut street 9th floor commonwealth tower
harrisburg, PA 17101
(717) 346-8156
Medicaid State Details as of
Retail Pharmacy Transactions - Fee For Service (FFS)
Drug Cost (submissions)
Drug cost type when 340B drugs are dispensed.
Drug Cost (reimbursements)
Drug cost type state plans reimburse at for 340B dispenses.
Required Claim Identifiers
Claim identifiers required to indicate 340B drugs were dispensed.
Professional Dispensing Fee (PDF)
The current professional dispensing fee for FFS 340B claims. Note: some states have ranges based on different factors.
Provider or Facility Administered Transactions Fee For Service (FFS)
Drug Cost (submissions)
Drug cost type when 340B drugs are administered.
Drug Cost (reimbursements)
Drug cost type state plans reimburse at for 340B dispenses.
Required Claim Identifiers
Claim identifiers required to indicate 340B drugs were administered.
Contract Pharmacies*
* Despite Federal position on dispensing through CP arrangements
Medicaid Managed Care Organization (MCO) Information
State uses MCO plans?
Does the state use MCO(s) to manage Medicaid services?
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MMCO Plans/Vendors |
Pharmacy Benefit Managers (PBMs) |
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All 340B stakeholders have equal access to technical assistance by contacting the Apexus Answers call center. We provide HRSA-aligned answers ranging from basic to complex, via phone 888.340.BPVP (2787), live chat, and email. We are here to help you navigate the 340B Program. Apexus Answers, celebrating ten years of service and support.
Pharmacy Reimbursement Amount Submitted The lower of the U&C or the 340B ceiling price on the claim for a 340B purchased drug. State Reimbursement - ""lowest of"" logicFor brand name drugs, the lower ofThe provider’s usual and customary charge to the general public;ORThe NADAC, or in the absence of NADAC, WAC minus 3.3%, plus a $10.00professional dispensing fee.For generic drugs, the lower ofThe provider’s usual and customary charge to the general public;ORThe NADAC, or in the absence of NADAC, WAC minus 50.5%, plus a $10.00professional dispensing fee;ORThe Federal Upper Limit plus a $10.00 professional dispensing fee;ORThe State Maximum Allowable Cost plus a $10.00 professional dispensing fee.