Prescription Drug Rights by State (2026)

Alabama has several laws affecting prescription drug access:

• Generic substitution: Alabama pharmacists may substitute a generic equivalent unless the prescriber indicates "dispense as written" (DAW)
• Medicaid coverage: Alabama Medicaid covers prescription drugs for eligible beneficiaries
• Right to Try: Alabama has a Right to Try law (Ala. Code § 22-54-1 et seq.) allowing terminally ill patients to access investigational drugs
• PBM regulations: Alabama has enacted pharmacy benefit manager regulations
• Alabama does not have a state-level prescription drug price cap or importation program

Arizona has specific protections and programs related to prescription drug access and affordability:

• Arizona Medicaid (AHCCCS) covers prescription drugs for eligible individuals
• Generic substitution is required by Arizona law — pharmacists must substitute a generic equivalent unless the prescriber specifically indicates brand is medically necessary (A.R.S. § 32-1963.01)
• Arizona passed the nation's first Right to Try Act (2014), allowing terminally ill patients to access investigational drugs not yet FDA-approved
• Arizona allows pharmacy price transparency — pharmacists can inform consumers about lower-cost alternatives
• Arizona does not cap insulin or other prescription drug prices at the state level
• Federal programs including Medicare Part D and 340B drug pricing apply to eligible Arizonans

Arkansas has enacted several laws to protect consumers regarding prescription drug costs and access:

• Arkansas requires pharmacy benefit manager (PBM) transparency — PBMs must be licensed and disclose pricing practices (Ark. Code § 23-92-601 et seq.)
• Arkansas enacted a law requiring PBMs to reimburse independent pharmacies at rates consistent with their own pharmacy subsidiaries
• Insurers must provide a 30-day emergency supply of maintenance medications in certain circumstances
• Arkansas participates in the federal Low Income Subsidy (LIS/Extra Help) program for Medicare Part D
• Pharmacists in Arkansas may substitute a lower-cost generic if one is available and the prescriber has not indicated otherwise
• The Arkansas Insurance Department regulates formulary and prior authorization practices for state-regulated plans

Colorado has enacted several laws to reduce prescription drug costs:

• Prescription Drug Affordability Board (SB 21-175): Colorado created a Prescription Drug Affordability Board to review and set upper payment limits on high-cost prescription drugs
• Insulin copay cap (SB 19-005): Colorado was one of the first states to cap insulin copays at $100 per month (per insulin type) for state-regulated health plans
• Generic substitution: Colorado law requires pharmacists to substitute a less expensive generic equivalent unless the prescriber specifies otherwise
• Pharmacy benefit manager (PBM) regulation: Colorado requires transparency in PBM pricing and prohibits gag clauses that prevent pharmacists from informing patients about lower-cost alternatives
• Canadian drug importation: Colorado has authorized a program to import prescription drugs from Canada (SB 19-005) to reduce costs
• Colorado Medicaid (Health First Colorado) covers prescription drugs for eligible residents

Connecticut has several laws affecting prescription drug access and affordability:

• Generic substitution is required by Connecticut law — pharmacists must dispense the generic equivalent unless the prescriber writes "brand medically necessary" or the patient requests the brand (CGS § 20-619)
• Connecticut established the Office of Health Strategy to monitor healthcare costs including prescription drugs
• Connecticut enacted prescription drug price transparency legislation requiring manufacturers to justify significant price increases
• Connecticut Medicaid and the state employee plan cover prescription drugs for eligible beneficiaries
• The Connecticut Pharmaceutical Assistance Contract to the Elderly and Disabled (ConnPACE) helps eligible seniors and disabled residents with prescription costs
• The Right to Try Act allows terminally ill patients to access investigational drugs

D.C. has enacted measures to protect consumers regarding prescription drug costs and access:

• D.C. Medicaid and Healthcare Alliance: D.C.'s expanded Medicaid (up to 210% FPL) and Healthcare Alliance programs cover prescription drugs for eligible residents with minimal or no copays
• Pharmacy benefit manager (PBM) regulation: D.C. has enacted legislation to increase transparency and oversight of PBMs that manage prescription drug benefits for health plans
• Generic substitution: D.C. pharmacists are required to offer generic substitutions when available unless the prescriber or patient objects (D.C. Code § 48-803.02)
• Prescription Drug Affordability Board: D.C. established a Prescription Drug Affordability Board to review drug costs and potentially set upper payment limits for expensive medications
• Emergency prescription access: D.C. pharmacists may dispense emergency refills of maintenance medications when the prescriber cannot be reached

Georgia has several laws affecting prescription drug access and costs:

• Generic substitution required: Georgia pharmacists must substitute a generic equivalent unless the prescriber specifies 'brand necessary' or the patient requests the brand
• Medicaid coverage: Georgia Medicaid covers prescription drugs for eligible beneficiaries
• Right to Try Act: Georgia has a Right to Try law allowing terminally ill patients to access investigational drugs that have completed Phase I FDA trials
• PBM regulations: Georgia has enacted pharmacy benefit manager (PBM) regulations to increase transparency and protect pharmacies from unfair reimbursement practices
• Georgia does not have a state-level prescription drug price cap or importation program

Hawaii has specific protections and programs related to prescription drug access:

• Hawaii's Prepaid Health Care Act ensures most workers have employer-sponsored insurance that includes prescription coverage
• Generic substitution is permitted by Hawaii law — pharmacists may substitute a generic equivalent unless the prescriber specifically indicates brand is medically necessary (HRS § 328-92)
• Hawaii has a prescription drug monitoring program (PDMP) to track controlled substance prescriptions and prevent abuse (HRS § 329-101)
• Hawaii enacted an insulin price cap — capping copays for insulin at $100 for a 30-day supply for insured individuals
• Hawaii Medicaid (Med-QUEST) covers prescription drugs for eligible individuals
• Federal programs including Medicare Part D and 340B drug pricing apply to eligible Hawaii residents

Indiana has specific protections and programs related to prescription drug access:

• Indiana Medicaid (HIP 2.0) covers prescription drugs for eligible individuals through managed care plans
• Generic substitution is permitted by Indiana law — pharmacists may substitute a generic equivalent unless the prescriber specifically indicates brand is medically necessary (IC § 16-42-22-10)
• Indiana enacted insulin price cap legislation — HEA 1405 (2023) caps insulin copays at $35 per 30-day supply for state-regulated health plans
• Indiana adopted the federal Right to Try Act framework allowing terminally ill patients to access investigational drugs
• Indiana regulates pharmacy benefit managers (PBMs) under IC § 27-1-24.5
• Federal programs including Medicare Part D and 340B drug pricing apply to eligible Hoosiers

Iowa protects consumers regarding prescription drug costs and access through state regulation and federal programs:

• Iowa regulates pharmacy benefit managers (PBMs) — PBMs operating in Iowa must be licensed and comply with transparency requirements
• Iowa law prohibits PBMs from engaging in certain anti-competitive practices that harm independent pharmacies
• Insurers must provide a 30-day emergency supply of maintenance medications in certain circumstances
• Iowa participates in federal programs (Medicare Part D Low Income Subsidy, Medicaid) to help lower drug costs for eligible residents
• Pharmacists in Iowa may substitute a lower-cost generic drug if available and the prescriber permits it
• The Iowa Insurance Division regulates formulary and prior authorization practices for state-regulated plans

Kansas has specific protections and programs related to prescription drug access:

• Kansas Medicaid (KanCare) covers prescription drugs for eligible individuals through managed care organizations
• Generic substitution is permitted by Kansas law — pharmacists may substitute a generic equivalent unless the prescriber specifically indicates "dispense as written" (K.S.A. § 65-1637)
• Kansas regulates pharmacy benefit managers (PBMs) to improve transparency in drug pricing
• Kansas adopted the federal Right to Try Act framework allowing terminally ill patients to access investigational drugs
• Kansas does not cap insulin or other prescription drug prices at the state level
• Federal programs including Medicare Part D and 340B drug pricing apply to eligible Kansans

Kentucky has several laws affecting prescription drug access:

• Generic substitution is required by Kentucky law — pharmacists must dispense the generic equivalent unless the prescriber specifies brand-name only or the patient requests the brand (KRS § 217.822)
• Kentucky has been at the center of the opioid crisis and enacted the KASPER (Kentucky All Schedule Prescription Electronic Reporting) system to monitor controlled substance prescriptions
• Kentucky Medicaid covers prescription drugs for eligible beneficiaries through managed care
• Kentucky has enacted PBM (pharmacy benefit manager) regulations to increase transparency
• The Right to Try Act allows terminally ill patients to access investigational drugs
• Kentucky does not have a state-level prescription drug price cap or importation program

Louisiana has several laws affecting prescription drug access:

• Generic substitution: Louisiana pharmacists must substitute a generically equivalent drug unless the prescriber writes "brand medically necessary" or the patient requests the brand (La. R.S. § 37:1226)
• Medicaid coverage: Louisiana Medicaid (expanded in 2016) covers prescription drugs for eligible beneficiaries, including low-income adults
• PBM regulations: Louisiana has enacted pharmacy benefit manager regulations to increase transparency and protect pharmacies
• Right to Try: Louisiana has a Right to Try law allowing terminally ill patients to access investigational drugs
• Louisiana does not have a state-level prescription drug price cap or importation program

Massachusetts provides prescription drug protections through multiple state programs and regulations:

• MassHealth covers prescription drugs for eligible residents with minimal copays
• The Prescription Advantage program helps seniors and people with disabilities who are not eligible for MassHealth by supplementing Medicare Part D coverage and filling coverage gaps
• Generic substitution is required by law — pharmacists must dispense the generic equivalent unless the prescriber writes "brand medically necessary" (MGL c. 112, § 12D)
• MA Drug Pricing Transparency law requires pharmaceutical companies to justify price increases and report pricing data to the Health Policy Commission
• The MA Health Policy Commission sets a health care cost growth benchmark that applies to prescription drug spending
• MA residents can import prescription drugs from certain international pharmacies under limited circumstances
• Insurers must maintain formularies and cannot impose unreasonable step therapy requirements without an exceptions process

Michigan provides prescription drug protections through Medicaid, generic substitution laws, and discount programs:

• Michigan Medicaid covers prescription drugs for enrolled beneficiaries under the Healthy Michigan Plan and traditional Medicaid
• Generic substitution is allowed and encouraged — pharmacists may substitute a generically equivalent drug unless the prescriber writes "dispense as written" (MCL § 333.17755)
• The MI Health Link program integrates Medicare and Medicaid prescription benefits for eligible dual-eligible individuals
• The MiRx prescription discount program provides a free discount card to uninsured and underinsured Michigan residents
• Michigan Pharmaceutical programs for seniors help reduce out-of-pocket drug costs
• Michigan follows the federal 340B Drug Pricing Program for qualifying hospitals and clinics

Minnesota has enacted several laws to protect consumers and reduce prescription drug costs:

• Insulin affordability (Alec Smith Insulin Affordability Act, 2020): Minnesota provides an emergency 30-day insulin supply for $35 at the pharmacy for uninsured or underinsured individuals. A continuing supply program is also available.
• Generic substitution: Minnesota law requires pharmacists to substitute a less expensive generic equivalent unless the prescriber specifies otherwise (Minn. Stat. § 151.21)
• Pharmacy benefit manager (PBM) regulation: Minnesota requires transparency in PBM pricing and prohibits PBMs from engaging in deceptive practices
• Drug price transparency: Minnesota has enacted drug pricing transparency requirements for pharmaceutical manufacturers
• MinnesotaCare and Medical Assistance: These programs cover prescription drugs for eligible low-income residents
• Canadian drug importation: Minnesota has explored programs to import prescription drugs from Canada to reduce costs

Mississippi residents have limited state-level prescription drug protections but can access federal programs:

• Mississippi does not have a robust state PBM regulation law — federal and limited state rules apply
• Pharmacists in Mississippi may substitute a lower-cost generic drug if available and the prescriber permits substitution
• Mississippi Medicaid covers prescription drugs for eligible residents — the formulary is managed by the Division of Medicaid
• Residents can access federal programs including Medicare Part D, Low Income Subsidy (Extra Help), and pharmaceutical manufacturer patient assistance programs
• Mississippi participates in the 340B drug pricing program through qualifying health centers and hospitals
• The Mississippi State Board of Pharmacy regulates pharmacy practices and can address pharmacy-level complaints

Missouri residents have state and federal protections regarding prescription drug costs and access:

• Missouri enacted PBM regulation (RSMo § 376.388 et seq.) requiring pharmacy benefit managers to be licensed and prohibiting certain anti-competitive practices
• Missouri law prohibits PBMs from paying independent pharmacies less than their affiliated pharmacies for the same drugs
• Insurers must provide emergency supplies of maintenance medications and cannot require step therapy that would delay effective treatment
• Missouri participates in federal programs including Medicare Part D, Low Income Subsidy, and Medicaid (MO HealthNet)
• Pharmacists in Missouri may substitute a lower-cost generic if available and the prescriber permits it
• Missouri's Medicaid program covers prescription drugs — contact MO HealthNet for formulary and coverage questions

Nebraska has specific protections and programs related to prescription drug access:

• Nebraska Medicaid (Heritage Health) covers prescription drugs for eligible individuals
• Generic substitution is permitted by Nebraska law — pharmacists may substitute a generic equivalent unless the prescriber specifically indicates brand is medically necessary (Neb. Rev. Stat. § 71-1,147.35)
• Nebraska enacted a Right to Try Act allowing terminally ill patients to access investigational drugs not yet FDA-approved
• Nebraska has a prescription drug monitoring program (PDMP) to track controlled substance prescriptions and prevent abuse
• Nebraska does not cap insulin or other prescription drug prices at the state level
• Federal programs including Medicare Part D and 340B drug pricing apply to eligible Nebraskans

Nevada has enacted some of the nation's most notable prescription drug pricing transparency laws:

• Nevada passed SB 539 (2017), the first state law requiring pharmaceutical companies to disclose costs and profits for certain diabetes drugs — a landmark transparency measure
• Generic substitution is required — pharmacists must substitute a generic equivalent unless the prescriber specifically indicates brand is medically necessary
• Nevada Medicaid covers prescription drugs for eligible individuals
• Nevada allows pharmacy price transparency — pharmacists can inform consumers about lower-cost alternatives
• Nevada does not cap insulin or other prescription drug prices at the state level, though transparency laws aim to reduce costs
• Federal programs including Medicare Part D and 340B drug pricing apply to eligible Nevadans

New Hampshire has provisions addressing prescription drug access and costs:

• Generic substitution (RSA 318:47-d): New Hampshire pharmacists are required to substitute a less expensive generic equivalent unless the prescriber writes "brand medically necessary" on the prescription. This helps reduce out-of-pocket costs.
• NH Medicaid coverage: NH Healthy Families (Medicaid) provides prescription drug coverage for eligible residents. New Hampshire expanded Medicaid under the ACA, increasing access to prescription drug benefits.
• Pharmacy benefit manager regulation: New Hampshire regulates PBMs to promote transparency in drug pricing and formulary decisions.
• Drug price concerns: New Hampshire does not have a state drug importation program or drug price transparency law, but legislative proposals have been introduced to address rising prescription costs.
• Patient assistance programs: Many pharmaceutical manufacturers offer patient assistance programs for NH residents who cannot afford medications. The NH Department of Health and Human Services maintains information about available programs.

New Mexico provides prescription drug protections and access programs:

• Generic substitution is required — pharmacists must substitute a generic equivalent unless the prescriber specifically indicates brand is medically necessary (NMSA § 26-3-3)
• New Mexico Medicaid covers prescription drugs for eligible individuals, with one of the broadest eligibility criteria in the nation
• New Mexico allows pharmacists to inform consumers about lower-cost alternatives
• The New Mexico Board of Pharmacy regulates pharmacy practices and consumer protections
• New Mexico has addressed prescription drug access in rural communities through expanded pharmacy provisions
• Federal programs including Medicare Part D and 340B drug pricing apply to eligible New Mexicans

North Carolina regulates prescription drug access and costs through state pharmacy laws and expanded Medicaid coverage:

• NC Medicaid covers prescription drugs for eligible enrollees, with coverage significantly expanded following the 2023 Medicaid expansion
• Generic substitution is allowed and encouraged — pharmacists may substitute a generic equivalent unless the prescriber or patient specifically requests the brand name (N.C. Gen. Stat. § 90-85.28)
• The NC Pharmacy Practice Act (N.C. Gen. Stat. Ch. 90, Art. 4A) regulates pharmacies and pharmacist conduct
• Pharmacists must inform patients when a less expensive generic equivalent is available
• NC participates in prescription assistance programs for seniors and low-income residents
• Mail-order pharmacy is permitted under NC law with appropriate licensing
• NC follows federal requirements for Medicare Part D prescription drug coverage

Ohio has several provisions related to prescription drug access and cost:

• Ohio Medicaid: Covers prescription drugs for eligible Ohioans, including expanded Medicaid population
• Generic substitution (ORC § 4729.38): Pharmacists are allowed to substitute generic equivalents unless the prescriber or patient requests the brand-name drug
• Drug Price Relief Act: Ohio Issue 2 (2017) would have required the state to pay no more than the VA pays for drugs, but it was defeated by voters
• PBM transparency: Ohio has enacted pharmacy benefit manager (PBM) transparency requirements, including restrictions on spread pricing in Medicaid managed care
• Ohio participates in the federal 340B drug pricing program for eligible healthcare organizations

Oklahoma has several laws affecting prescription drug access:

• Generic substitution is permitted in Oklahoma — pharmacists may substitute a generic equivalent unless the prescriber specifically prohibits it by writing "brand medically necessary" (Okla. Stat. tit. 59 § 353.13a)
• Oklahoma has been at the center of the opioid crisis and enacted the Anti-Drug Diversion Act, with strict monitoring of controlled substance prescriptions through the PMP (Prescription Monitoring Program)
• Oklahoma Medicaid covers prescription drugs for eligible beneficiaries
• Oklahoma enacted PBM (pharmacy benefit manager) transparency legislation
• The Right to Try Act allows terminally ill patients to access investigational drugs
• Oklahoma does not have a state-level prescription drug price cap or importation program

Oregon has enacted several laws to protect consumers and reduce prescription drug costs:

• Prescription Drug Affordability Board (HB 2958, 2023): Oregon established a Prescription Drug Affordability Board to review and set upper payment limits on high-cost prescription drugs
• Generic substitution: Oregon law requires pharmacists to substitute a less expensive generic equivalent unless the prescriber specifies otherwise (ORS § 689.515)
• Pharmacy benefit manager (PBM) regulation: Oregon requires PBM transparency and prohibits PBMs from engaging in spread pricing or certain rebate practices that increase costs for consumers
• Drug price transparency: Oregon has enacted drug pricing transparency requirements — manufacturers must report price increases above a certain threshold
• Oregon Health Plan (OHP): Oregon Medicaid covers prescription drugs for eligible low-income residents through a preferred drug list
• Patient assistance: Oregon's Prescription Drug Program helps uninsured and underinsured residents access medications at reduced costs

Rhode Island has enacted provisions to improve prescription drug access and affordability:

• Generic substitution (R.I. Gen. Laws § 21-31-16): Rhode Island pharmacists are required to substitute a less expensive generic equivalent unless the prescriber writes "brand medically necessary." This requirement helps reduce out-of-pocket costs.
• Cost transparency: Rhode Island has pursued drug price transparency measures, requiring reporting on significant price increases for certain medications.
• Medicaid coverage (RIte Care): Rhode Island Medicaid provides comprehensive prescription drug coverage for eligible residents. The state expanded Medicaid under the ACA.
• Pharmacy benefit manager regulation: Rhode Island regulates PBMs through the Department of Business Regulation, promoting transparency in drug pricing and formulary decisions.
• Prescription assistance: Rhode Island's Department of Human Services provides information about pharmaceutical assistance programs available to residents who cannot afford medications.

South Carolina has several laws affecting prescription drug access:

• Generic substitution: SC pharmacists must substitute a generic equivalent unless the prescriber writes "brand medically necessary" or the patient requests the brand
• Medicaid coverage: SC Medicaid covers prescription drugs for eligible beneficiaries
• PBM regulations: SC has enacted pharmacy benefit manager regulations to increase transparency
• Right to Try: SC has a Right to Try law allowing terminally ill patients to access investigational drugs
• SC does not have a state-level prescription drug price cap or importation program

Utah has specific protections and programs related to prescription drug access:

• Utah Medicaid covers prescription drugs for eligible individuals through managed care plans
• Generic substitution is required by Utah law — pharmacists must substitute a generic equivalent unless the prescriber specifically indicates brand is medically necessary (Utah Code § 58-17b-605a)
• Utah allows pharmacy benefit manager (PBM) transparency — the state has enacted laws requiring PBMs to disclose certain pricing information
• Utah adopted the federal Right to Try Act framework allowing terminally ill patients to access investigational drugs
• Utah does not cap insulin or other prescription drug prices at the state level
• Federal programs including Medicare Part D and 340B drug pricing apply to eligible Utahns

Virginia regulates prescription drug access and costs through several state-level provisions:

• Virginia Medicaid covers prescription drugs for eligible enrollees, including those covered under the 2019 Medicaid expansion
• Generic substitution is allowed under Va. Code § 54.1-3401 — pharmacists may substitute a generic equivalent unless the prescriber or patient requests the brand-name drug
• Virginia established a Prescription Drug Affordability Board to study and address high prescription drug costs
• Virginia has Right to Try provisions allowing terminally ill patients to access investigational drugs that have completed Phase I FDA trials
• Virginia regulates pharmacy benefit managers (PBMs) and requires transparency in drug pricing practices
• Virginia Medicaid provides a formulary with covered medications and a prior authorization process for non-formulary drugs

Washington has among the strongest prescription drug cost protections in the nation:

• Generic substitution is required by law (RCW 69.41.120) — pharmacists must substitute a less expensive generic equivalent unless the prescriber specifies otherwise
• The Washington Prescription Drug Affordability Board (2024) reviews and sets upper payment limits on high-cost prescription drugs
• Insulin copay cap: $35 per month for state-regulated health plans — one of the first states to enact this protection
• Washington Medicaid (Apple Health) covers prescription drugs for eligible residents
• Washington has importation and bulk purchasing programs to reduce drug costs
• Pharmacy benefit manager (PBM) regulation requires transparency in drug pricing
• Washington prohibits gag clauses that prevent pharmacists from telling patients about lower-cost alternatives

West Virginia provides prescription drug protections and access programs:

• Generic substitution is permitted — pharmacists may substitute a generic equivalent unless the prescriber specifically indicates brand is medically necessary (W. Va. Code § 30-5-12b)
• West Virginia Medicaid covers prescription drugs for eligible individuals
• West Virginia has addressed the opioid epidemic through prescription drug monitoring programs (PDMP) — all controlled substance prescriptions must be checked against the PDMP
• The West Virginia Board of Pharmacy regulates pharmacy practices and consumer protections
• West Virginia's Drug Utilization Review Board monitors prescription drug utilization under Medicaid
• Federal programs including Medicare Part D and 340B drug pricing apply to eligible West Virginians

Wisconsin residents have meaningful state and federal protections regarding prescription drug costs and access:

• Wisconsin regulates pharmacy benefit managers (PBMs) — PBMs must be licensed and comply with transparency and anti-discriminatory pricing requirements (Wis. Stat. § 632.865)
• Wisconsin law prohibits PBMs from paying independent pharmacies below cost or at rates below their affiliated pharmacies for the same drugs
• Insurers must provide emergency supplies of maintenance medications and cannot impose unlimited prior authorization burdens
• Wisconsin participates in federal programs including Medicare Part D, Low Income Subsidy, and BadgerCare Plus (Medicaid)
• Pharmacists in Wisconsin may substitute a lower-cost generic if available and the prescriber permits it
• The Wisconsin Office of the Commissioner of Insurance regulates prescription drug coverage in state-regulated plans

Wyoming prescription drug protections focus on basic access in a largely rural state:

• Generic substitution (Wyo. Stat. § 33-24-157): Pharmacists may substitute a less expensive generic equivalent unless the prescriber indicates "dispense as written" on the prescription or the patient declines the substitution.
• Prescription drug monitoring program (PDMP): Wyoming operates a PDMP that tracks controlled substance prescriptions to prevent abuse and diversion. Prescribers must check the PDMP before prescribing Schedule II controlled substances.
• No state drug importation program: Wyoming has not enacted a prescription drug importation program. Residents rely on existing pharmacy networks and mail-order options for medication access.
• Medicaid prescription coverage: Wyoming Medicaid covers prescription drugs for eligible residents. The state uses a preferred drug list and may require prior authorization for certain medications.
• 340B drug pricing: Eligible healthcare facilities in Wyoming (including critical access hospitals and federally qualified health centers) can access discounted drug prices through the federal 340B program, which is important for Wyoming's rural healthcare infrastructure.