California, New York and Ohio led all states in gross Medicaid prescription drug spending in fiscal year 2024, accounting for more than a quarter of national spend, according to a KFF analysis of federal data.
The figures reflect gross spending before manufacturer rebates on covered outpatient drugs under the Medicaid Drug Rebate Program, drawn from CMS state drug utilization data and CMS-64 financial management reports in April. Because CMS suppresses data for drug records with fewer than 11 prescriptions, state totals do not sum to the reported national figure of $103.6 billion. Manufacturers participating in the MDRP are required to rebate a portion of payments back to states; most states also negotiate supplemental rebates on top of federal statutory amounts, meaning net spending is lower than the figures shown here.
States ranked by gross Medicaid prescription drug spend in FY 2024:
- California — $14.83 billion
- New York — $10.4 billion
- Ohio — $4.51 billion
- Pennsylvania — $4.5 billion
- Virginia — $4.45 billion
- Michigan — $3.74 billion
- Texas — $3.54 billion
- Florida — $3.32 billion
- Illinois — $3.12 billion
- North Carolina — $2.87 billion
- Indiana — $2.74 billion
- Louisiana — $2.47 billion
- Massachusetts — $2.27 billion
- Kentucky — $2.13 billion
- New Jersey — $1.97 billion
- Wisconsin — $1.95 billion
- Connecticut — $1.9 billion
- Arizona — $1.88 billion
- Missouri — $1.81 billion
- Maryland — $1.72 billion
- Washington — $1.65 billion
- Tennessee — $1.49 billion
- Colorado — $1.46 billion
- Georgia — $1.30 billion
- Minnesota — $1.05 billion
- Alabama — $1.02 billion
- Oklahoma — $972.2 million
- Oregon — $899.6 million
- West Virginia — $834.8 million
- Iowa — $793.9 million
- South Carolina — $696.7 million
- Nevada — $659.9 million
- New Mexico — $594.4 million
- Mississippi — $568.2 million
- Idaho — $550.5 million
- Maine — $489.8 million
- Arkansas — $462.5 million
- Nebraska — $460 million
- Montana — $375M
- Utah — $360.7M
- Kansas — $348.8M
- Rhode Island — $307.2M
- Hawaii — $298.4M
- District of Columbia — $281.5M
- Delaware — $268M
- New Hampshire — $230.3M
- South Dakota — $228.6M
- Alaska — $193.6M
- Vermont — $179.1M
- North Dakota — $96.8M
- Wyoming — $43.2M
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