Generics fill 86% of Medicaid prescriptions and take 11% of the spending

State Medicaid programs paid for about 725 million prescriptions in 2025. Generic drugs filled 85.7 percent of them and accounted for 11.4 percent of the $116.9 billion that programs reimbursed pharmacies before rebates, according to a GxRadar analysis of the federal State Drug Utilization Data for 2025¹.

Eleven years earlier the split looked different. In 2014, generics filled 80.8 percent of Medicaid prescriptions and took 24.5 percent of the money, the 2014 file³ shows. Generics' share of the pills rose by five points while their share of the dollars fell by more than half.

Most of that gap comes from the brand side. Generic spending barely moved in those years, from $12.0 billion to $13.3 billion. What changed was the cost of brand-name drugs, and especially of drugs with no generic competitor at all.

How GxRadar counted

States report every outpatient drug they pay for to CMS, by National Drug Code, quarter and program type, as part of the Medicaid Drug Rebate Program. CMS posts the reports on Medicaid.gov⁴ and data.medicaid.gov, including a national total row for each drug code. GxRadar summed those national rows for each year from 2014 through 2025.

Nothing in the utilization files says which drugs are generic. To classify them, GxRadar matched each drug code to CMS's Drug Products in the Medicaid Drug Rebate Program⁵ file, which assigns every product a drug category: single source (S), innovator multiple source (I) or non-innovator multiple source (N). CMS's NADAC methodology⁶ explains that S and I products are generally treated as brands and N products as generics. GxRadar counted N as generic and S plus I as brand. Fewer than 0.5 percent of prescriptions in any year had no match.

Two quirks follow from that rule. Authorized generics, which are brand drugs sold under a generic label, are listed as I products because FDA approved them under a New Drug Application, so they count as brand here (GxRadar explains authorized generics separately). And over-the-counter generics that Medicaid covers with a prescription count as generic. Those OTC products were about 7.4 percent of all Medicaid prescriptions in 2024. Leaving them out, prescription-only generics were 85.1 percent of 2024 prescriptions and 12.4 percent of spending.

MACPAC, the congressional advisory commission on Medicaid and CHIP, used the same approach in its FY 2022 data book exhibit⁸. MACPAC put generics at 15.2 percent of fiscal 2022 gross spending. GxRadar's calendar 2022 figure is 16.2 percent.

Twelve years of Medicaid prescriptions

Dollar figures are the "total amount reimbursed" field, which includes the Medicaid payment plus any amount paid by other insurers or patients, before manufacturer rebates. Averages are dollars per prescription.

Source: GxRadar analysis of CMS State Drug Utilization Data national rows (2024 file shown here²; one file per year) matched to the CMS drug product file. Files for 2020 through 2025 are the versions CMS updated in July 2026.

The average generic prescription cost $23.83 in 2014 and $21.40 in 2025. The average brand prescription tripled, from $316 to $1,006. That fits the long decline in pharmacy costs GxRadar tracks in its generic price index, which stood at 47.4 in October 2026 against a January 2014 base of 100, down about 53 percent. Our analysis of what happens to Medicaid spending when the first generic arrives looks at the same shift drug by drug.

Where the money went

Single-source drugs, the brands with no generic on the market, drive the dollar column. In 2025 they were 8.7 percent of Medicaid prescriptions and 79.3 percent of gross reimbursement, at an average of $1,473 per prescription. In 2014 the same category held 41.2 percent of the money.

Older brands with generic rivals, the I category, moved the other way. Their share of prescriptions fell from 11.9 percent in 2014 to 5.5 percent in 2025, and their share of dollars from 34.2 percent to 9.3 percent, as generic versions arrived for more of those molecules. GxRadar's piece on why generic prices fall as competitors enter covers what drives that switch, and how Medicaid pays for generic drugs covers the payment rules.

Prescription counts also moved. Volume peaked at 784 million in 2023 and fell to 725 million in 2025. GxRadar did not analyze the cause.

Before rebates and after

All of the dollar figures above are gross. Manufacturers pay rebates back to states under the Medicaid Drug Rebate Program, and those rebates are large. MACPAC's FY 2023 exhibit⁷ counts $104.9 billion in gross drug spending against $53.7 billion in rebates, about 51 percent.

The rebate formulas are not symmetric. For brand drugs, CMS's unit rebate amount page⁹ lists the basic rebate as the greater of 23.1 percent of the average manufacturer price or the gap between that price and the best price, plus an inflation adjustment. Generic (N) drugs have their own basic and additional rebate calculation. The public files do not report rebates by drug, so a net generic share cannot be computed from them. With rebates equal to about half of gross spending, net shares could look quite different from the gross shares in the table.

Medicaid next to Medicare

Medicare Part D shows nearly the same split, as our piece on the generic share of Part D details. CMS's Part D grand totals report¹⁰ for 2024 classifies drugs by FDA application type, ANDA for generics, which differs slightly from Medicaid's categories.

Both programs sit close to the national figure HHS cites. A January 2025 ASPE issue brief¹¹ said an estimated 91 percent of all US prescriptions in 2022 were filled as generics. GxRadar's guide to how Medicare Part D pays for generics covers the Medicare side, and more policy coverage is on the Law, patents and policy desk.

What the next files will show

States can revise past quarters, and CMS reposts the files; the 2020 through 2025 files GxRadar used were dated July 2026 on data.medicaid.gov¹. CMS has already opened a 2026 file¹², last updated in July 2026, which will show whether the generic share of dollars keeps falling below 11 percent.