PBM Reimbursement Tracker
What does your state require?
A plain-language, source-cited entry for each state — the reimbursement basis, the effective date, and the appeal route. Every entry links the primary statute or agency it rests on.
| State | Status | Reimbursement basis | Effective | |
|---|---|---|---|---|
| Arkansas | Enacted | Prohibits MAC reimbursement below the pharmacy's acquisition cost (wholesaler invoice price); MAC lists must be updated within 7 days of a qualifying cost increase | Signed April 1, 2015; upheld by the U.S. Supreme Court in Rutledge v. PCMA (8–0, Dec. 10, 2020) | View → |
| Colorado | Partially enacted | No NADAC or acquisition-cost floor; MAC-list sourcing and transparency rules only | MAC regime in effect; HB 1094 flat-fee model effective 2027 | View → |
| Indiana | Enacted | The greater of the PBM's affiliated-pharmacy rate or NADAC plus the Medicaid professional dispensing fee (acquisition cost plus a fair dispensing fee for liquor-permit pharmacies) | Applies to policies or contracts issued, renewed, or amended after December 31, 2025 (effective January 1, 2026) | View → |
| Iowa | Enacted | No less than NADAC (or WAC where NADAC is unavailable) for Iowa retail pharmacies | July 1, 2025 (enforcement partially enjoined as to ERISA-plan plaintiffs) | View → |
| Kansas | Partially enacted | No reimbursement floor; MAC-list construction and update rules only | MAC list/appeal requirements in effect; PBM licensure effective January 1, 2023 | View → |
| Kentucky | Enacted | No less than NADAC (or WAC where NADAC is unavailable), using the most recent monthly NADAC; reconciliation clawbacks below this are prohibited | Applies to PBM contracts issued, renewed, extended, or amended on or after January 1, 2025 | View → |
| Louisiana | Enacted | No reimbursement below acquisition cost, defined as NADAC; PBMs must use a NADAC-based reimbursement formula plus a professional dispensing fee | January 1, 2026 (the 2024 SB 444 acquisition-cost floor took effect Jan 1, 2025 and is superseded) | View → |
| Maine | Enacted | Payment must be ingredient cost plus a dispensing fee, less cost-sharing; ingredient cost may not exceed MAC or average wholesale price | 2019 | View → |
| Maryland | Partially enacted | Commercial: no NADAC floor; a PBM may not pay a pharmacy less than it pays its own affiliate. Medicaid: at least NADAC plus the Medicaid professional dispensing fee | Commercial MAC rules effective 2020; Medicaid below-NADAC reporting from January 1, 2022 | View → |
| Minnesota | Partially enacted | Commercial: no acquisition-cost floor (MAC transparency only). Medicaid: lesser of NADAC or actual acquisition cost, plus the Medicaid professional dispensing fee | Commercial MAC regime since January 1, 2020; Medicaid NADAC floor effective January 1, 2027 (interim $4.50 dispensing payment from July 1, 2025) | View → |
| Mississippi | Enacted | Acquisition-cost floor enforced through appeals (PBM must pay at least the pharmacy's acquisition cost on a successful appeal); no below-affiliate reimbursement | January 1, 2021 | View → |
| Montana | Enacted | No less than NADAC (the price in effect the day the claim was billed) plus a professional dispensing fee; if no NADAC is published, 100% of WAC plus the fee | Applies to conduct on or after October 1, 2025 (sunsets June 30, 2029) | View → |
| New Mexico | Partially enacted | Reimbursement must be based on objective, verifiable sources and no less than what the PBM pays its own affiliate; no NADAC or acquisition-cost floor | July 1, 2023 | View → |
| New York | Pending | No reimbursement floor currently in force (the proposed NADAC + dispensing-fee floor was withdrawn from the 2024 rule). Pending S5939 would require at least NADAC, or acquisition cost if greater, plus the Medicaid professional dispensing fee | DFS market-conduct rules effective November 27, 2024; S5939 floor would take effect January 1, 2026 if signed | View → |
| North Dakota | Partially enacted | No acquisition-cost or NADAC floor; MAC prices may not be set below the PBM's own pricing sources, and dispensing fees are excluded from the MAC calculation | MAC statute in effect; HB 1584 effective April 29, 2025 (licensing provision January 1, 2026) | View → |
| Oklahoma | Partially enacted | No NADAC or acquisition-cost floor; PBM may not reimburse an independent less than a PBM-affiliated pharmacy; spread pricing prohibited | MAC/appeal provisions in effect; 2025 spread-pricing and transparency amendments effective in 2025 | View → |
| Tennessee | Enacted | No reimbursement below the pharmacy's documented actual acquisition cost; spread pricing prohibited | Below-cost reimbursement and appeal provisions effective January 1, 2023 | View → |
| Texas | Partially enacted | No reimbursement floor; MAC-list construction and update rules only | MAC/appeal regime in effect since 2015 | View → |
| West Virginia | Enacted | No less than NADAC plus a $10.49 professional dispensing fee (or WAC plus $10.49 where NADAC is unavailable) | January 1, 2022 | View → |
Coverage is expanding. A state not listed yet does not mean it has no law — only that its entry is not yet published. See how entries are compiled.