Searchable state-by-state Medicaid 340B requirements
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.
Technical contact
MEDIMPACT HEALTHCARE SYSTEMS INC.
cheriann harrison
CHERIEANN.HARRISON@MEDIMPACT.COM
10181 scripps gateway ct
san diego, CA 92131
(858) 339-6156
Rebate contact
MEDIMPACT HEALTHCARE SYSTEMS INC.
felicia dipaolo
10181 scripps gateway ct
san diego, CA 92131
(804) 349-6086
Policy contact
KENTUCKY DEPT FOR MEDICAID SERVICES
fatima ali
275 e main street
frankfort, KY 40601
(502) 564-6890
Kentucky Medicaid State Details as of 16-SEP-25
Retail Pharmacy Transactions - Fee For Service (FFS)
FFS Pharmacy Benefit Manager
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.
Medicaid Managed Care Organization (MCO) Information
State uses MCO plans?
Does the state use MCO(s) to manage Medicaid services?
|
MMCO Plans/Vendors |
Pharmacy Benefit Managers (PBMs) |
|---|---|
| Aetna Better Health | MedImpact Healthcare Systems |
| Humana | MedImpact Healthcare Systems |
| Passport | MedImpact Healthcare Systems |
| United Healthcare | MedImpact Healthcare Systems |
| WellCare | MedImpact Healthcare Systems |
Retail Pharmacy Transactions - Medicaid Managed Care Organization (MCO)
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 - Medicaid Managed Care Organization (MCO)
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.
For MCO: HCPCS code in field 44 followed by one of the acceptable modifiers above. It is important that the CE is contacting their appropriate MCO to confirm what modifier should be utilized as each MCO can utilize either of the required ones.
Contract Pharmacies*
* Despite Federal position on dispensing through CP arrangements
"Starting 1/1/2024, pharmacy providers submitting 340B claims for Kentucky FFS members should submit the actual acquisition cost (AAC) under INGREDIENT COST SUBMITTED (NCPDP field #409-D9). Providers should submit the actual usual & customary (U&C) value under USUAL AND CUSTOMARY CHARGE (NCPDP field #426-DQ). Submission Clarification Code ""20"" and Basis of Cost Determination ""8"" are optional. 340B purchased drugs for Medicaid members will be reimbursed no more than their actual acquisition cost or the amount determined by the lowest of logic in Section A. I., whichshall include the 340B Ceiling Price, plus the professional dispensing fee. Lowest of Logic includes: a. The National Average Drug Acquisition Cost (NADAC), plus the professional dispensingfee; orb. The Wholesale Acquisition Cost (WAC) plus zero percent (0%), plus the professionaldispensing fee; orc. The Federal Upper Limit (FUL), plus the professional dispensing fee; ord. The Maximum Allowable C