Medicaid and 340B Drug Pricing Programs

Medicaid Pharmacy Benefits

Medicaid is a joint federal-state program providing healthcare coverage to low-income individuals. Medicaid drug benefits vary by state but typically offer low or no copays for covered medications. Federal law requires drug manufacturers to provide rebates to Medicaid programs.

Pharmacy technicians working with Medicaid patients should understand that coverage and formularies differ from state to state. Some states require generic substitution when available and may have quantity limits and prior authorization requirements.

The 340B Drug Pricing Program

The 340B program requires drug manufacturers to provide outpatient drugs at discounted prices to eligible healthcare organizations serving low-income and uninsured patients. Eligible entities include federally qualified health centers, disproportionate share hospitals, and certain clinics.

Pharmacies participating in 340B programs must maintain careful records to prevent duplicate discounts (receiving both a 340B price and a Medicaid rebate on the same drug). This program is growing in importance in pharmacy operations.

Study for the PTCB

Government programs and pricing are tested on the PTCB exam. Use our flashcards and mini exams to prepare.