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Medicaid

Medicaid, a state administered program jointly funded by states and the federal government, provides health coverage for more than 74 million low-income Americans, including children and their parents, pregnant women, the elderly and people living with disabilities.

Each state designs their own Medicaid program within broad federal guidelines and can decide whether to provide prescription drug coverage, an optional benefit under the Medicaid program. All states currently provide prescription drug coverage with some states administering pharmacy benefits directly and other states using Medicaid managed care plans to deliver pharmacy benefits to beneficiaries.

Across the country, Medicaid spending on prescription medicines remains low. In 2016, Medicaid programs spent on average just 5 percent of their budgets on retail prescription medicines, a number that has remained consistent over time and is projected to remain a small share. At the same time, biopharmaceutical manufacturers paid more than $30.5 billion in 2016 in mandatory and negotiated supplemental rebates to the Medicaid program, shared between states and the federal government.

 

Medicaid in your State

Click your state below to learn more about Medicaid spending data and the value that drugs bring to the Medicaid program and patients.

LEARN MORE ABOUT MEDICAID SPENDING ACROSS THE ENTIRE UNITED STATES

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PhRMA Comments to CMS on Plan to Amend Tennessee’s Section 1115 Demonstration

PhRMA submitted the following comments on Tennessee's plan to amend Section 1115, a plan which requests new flexibilities and certain exemptions for TennCare administrators from federal oversight. PhRMA has grave concerns about the impact the drug-related proposals would have on Medicaid beneficiaries' access to crucial medications, and urges CMS not to approve these elements of Tennessee's proposal.

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Medicare Monday: Why Medicaid-Style Rebates Aren’t Good for Part D Beneficiaries or the Program

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