Medicaid drug rankings, 2025
State figures come from that state’s own rows. CMS hides any row with fewer than 11 prescriptions, so rare, high-cost drugs are undercounted at the state level, and a state’s numbers do not add up to its full Medicaid total.
Brand-name drugs and reference biologics account for — of Medicaid prescriptions but — of Medicaid spending. Generics fill — of prescriptions for — of spending.
Drug categories
Categories follow the FDA approval pathway (brand NDA, generic ANDA, biologic BLA, biosimilar 351(k)). Click a row to rank its drugs below. National totals, all of 2025.
| Category | Modality | Prescriptions | Share of Rx | Medicaid spending | Share of spending | Cost per Rx |
|---|
Top 25 drugs
Drugs are ranked by active ingredient, summing every package of that ingredient within the category.
By prescriptions
Paid prescriptions. Each fill or refill counts once.
By Medicaid spending
Medicaid amount reimbursed to pharmacies, before manufacturer rebates.
Estimated 2025 savings if prescriptions for brand-name drugs and reference biologics had been filled with their matched generic or biosimilar, nationally. Matches require the same ingredient, strength and form, and an FDA substitutability rating for generics.
Top 25 switching opportunities
Ranked by gross savings. "Already on alternative" is the share of this product's units already dispensed as the generic or biosimilar. Flags mark brands a state has put on its brand-preferred list (it found the brand cheaper after rebates) and switches that cost more after average rebates.
| Brand | Product | Switch to | Brand spending | Already on alternative | Gross savings | After min. rebates | After avg. rebates | Flags |
|---|
Proof of concept: matching across strengths
Not vetted. Here a brand matches any generic or biosimilar with the same ingredient and dose form, whatever the strength, and cost is compared per unit (tablet, mL). Per-unit prices differ by strength, so these figures need review before use. They are never added to the totals above.
| Brand | Product (any strength) | Brand spending | Gross savings | After avg. rebates |
|---|
- Brands match generics with the same RxNorm clinical drug (ingredient, strength and dose form) and an FDA "A" therapeutic-equivalence rating; authorized generics always match. Reference biologics match biosimilars with the same concentration, volume and device.
- The alternative's price is the volume-weighted average Medicaid paid per unit for the matched products in the same state (national when a state has too little volume).
- Minimum rebates use the statutory floor (23.1% of price for brands, 17.1% for clotting factors and pediatric drugs, 13% for generics). Average rebates use 61.9% for brands, calibrated to MACPAC's FY 2024 totals ($58.4B rebates on $106.4B gross); authorized generics and biosimilars stay at 23.1%. Rebates are applied to Medicaid paid amounts, and confidential state supplemental rebates are not included.
- Brand-preferred lists are compiled for SC, IA, MD, NH, OH and NY (2026 lists). Other states may have lists that are not yet included.
- Interchangeable biosimilars can be substituted by the pharmacy where state law allows. Other biosimilars need a new prescription.
Pick a product to see the generics, authorized generics or biosimilars sold at the same strength and form, and what each cost Medicaid per unit. Where none exists, the page says why, using FDA records. National figures, 2025.
Search for a product above, or click "Explore" next to any product in a Rankings popup.
- An alternative has the same ingredient, strength and dose form (RxNorm clinical drug) and the same billing unit. Generics must carry an FDA "A" therapeutic-equivalence rating; authorized generics always qualify. Biosimilars must match concentration, volume and device.
- Prices are national averages of what Medicaid paid per unit in 2025, before rebates. Savings estimates come from the Savings Opportunity Overview.
- When no alternative was dispensed, the reason comes from the FDA Orange Book (generic approvals, listed patents, exclusivities) or the Purple Book (licensed biosimilars, exclusivities). Listed patents can be challenged, settled or ruled invalid, so their dates are not guaranteed launch dates.