Florida and Pennsylvania operate two of the largest medical-only cannabis programs in the United States. Both states have refused to legalize adult recreational use through Congress or votes. Both built their medical infrastructure from scratch in the late 2010s. And today, both serve hundreds of thousands of patients through their pharmacy networks and generate more than $1 billion annually. However, if you look beyond these superficial similarities, the two programs behave very differently. Comparing them is a useful way to assess how Florida’s regulatory approach is working.
Number of patients
Florida’s program is by far the largest medical-only cannabis program in the country. As of December 2025, the state’s Office of Medical Cannabis Use reported there were 930,779 registered patients and 737 licensed dispensaries providing services. Pennsylvania’s program has 439,400 enrolled patients as of November 2025 and is served by 185 licensed pharmacies.
Although Florida’s population (approximately 23 million people) is larger than Pennsylvania’s (approximately 13 million people), this is not a significant factor in explaining the difference in case numbers. Adjusted per capita, approximately 4 percent of Florida residents are enrolled in a medical marijuana program. Pennsylvania’s rate is about 3.4%. Florida has seen a significant increase in its share of the population.
Growth in both states is expected to slow in 2025. Pennsylvania actually saw its net caseload drop by about 1,300 people from November 2024 to November 2025, an unusual reversal for a program that has seen increases every year since its inception. Florida added about 35,000 patients over the 11-month period in 2025, a significant decrease from the program’s initial growth rate. These slowdowns in both states tend to occur as medical-only programs reach maturity, and those who want access largely get it.
Sales quantity
Even though Florida has more than twice as many patients as Pennsylvania, annual revenue for both states is closer than the patient numbers would suggest. Florida’s medical marijuana market generated approximately $1.65 billion in retail sales in 2025. Pennsylvania’s market was worth more than $1.3 billion through the first three quarters of 2025 and about $1.8 billion at the end of the year, slightly more than Florida’s total.
The reason lies in product composition and pricing. Patients in Pennsylvania spend more per capita than patients in Florida. Average retail prices for flowers in Pennsylvania (down $7.59 per gram in 2025 from $14.90 in 2021) are consistent with a mature competitive market, but the program’s regulatory regulations are driving patients toward higher-margin products. Florida’s pricing is generally low and per capita patient spending reflects that. Short version: Florida provides more units to more patients at lower prices. Pennsylvania is moving fewer units to fewer patients, increasing revenue per patient.
Cumulative sales figures support this point. Pennsylvania’s medical program generated approximately $8.5 billion in retail sales from February 2018 to the end of 2025, making it the sixth largest retail cannabis market in the country, even though the program is medical-only and five neighboring states (New Jersey, New York, Maryland, Delaware, and Ohio) have legalized adult use.
Where the program diverges the most
Although Florida and Pennsylvania allow patients access to broadly similar medical cannabis products, the differences in what is allowed are important.
Smokable flower has been allowed in Florida since the state legalized smoking medical marijuana in 2019 after Gov. Ron DeSantis signed a bill lifting the previous ban. Pennsylvania currently does not have one. Patients in Pennsylvania can purchase dried leaf flower, but state law only allows it to be vaporized, not smoked. The Medical Cannabis Act completely prohibits burning.
Pennsylvania also bans traditional edible cannabis. Gummies, chocolates and infused cookies are not sold at dispensaries in Pennsylvania. Patients who prefer oral administration may receive tablets, capsules, tinctures, or recently approved dissolving-in-the-mouth lozenges and lozenges.
Both restrictions were deliberate policy choices, originally framed around prevention of diversion to minors and concerns about the health effects associated with combustion. For patients in Pennsylvania, this tradeoff is important. For those who aren’t satisfied with evaporation, don’t have easy access to tinctures, or want predictable dosing for edibles, Florida offers options that Pennsylvania doesn’t. Pennsylvania’s approach has long been at odds with policymakers concerned about the appeal of product formats to young people and the health risks of combustion.
Possession restrictions are also different. Florida assigns specific milligram THC limits for each route of administration that are set for each patient by a qualified physician. Pennsylvania allows up to a 90-day supply (defined as 192 units of legal medical marijuana) per certification, with the actual amount determined by a physician.
Eligibility: Florida is slightly more lenient
Florida’s list of eligible conditions (under Florida Statutes Section 381.986) includes the inclusion of cancer, epilepsy, glaucoma, HIV/AIDS, PTSD, ALS, Crohn’s disease, Parkinson’s disease, multiple sclerosis, terminal conditions, chronic non-malignant pain caused by a qualifying condition, and “other debilitating medical conditions of the same type or class” as the conditions listed. The omnibus clause gives Florida physicians some discretion.
Pennsylvania has 24 serious medical conditions that are specifically enumerated, including most of the conditions listed by Florida, as well as several conditions that Florida does not list: anxiety disorders, Tourette syndrome, and opioid use disorder when traditional therapeutic interventions are ineffective. Pennsylvania’s list is more specific, but less flexible. There is no comparable comprehensive provision in Pennsylvania statutes.
The practical effect is that doctors in both states will find that patients’ symptoms largely overlap, but Pennsylvania’s inclusion of anxiety as a qualifying condition (added in 2019) and opioid use disorder (added in 2018, when Pennsylvania became the first state to formally approve cannabis as a treatment for opioid use disorder) reflect a slightly broader view of what medical marijuana can treat. Doctors in Florida may be able to achieve similar results through a catch-all, but documentation is more complicated. Across the broader state medical program, patients can determine whether their particular diagnosis is recognized as a qualifying condition before scheduling a qualifying visit.
Telemedicine and certification process
Although both states allow telehealth-based certification, there are significant differences. Pennsylvania allows the entire certification process (initial and renewal) to be conducted via video consultation. In Florida, initial certification is required in person. Only follow-up updates (starting with House Bill 387 of 2023) can be performed via telehealth. Florida requires qualified physicians to complete a state-mandated two-hour course conducted by the Florida Medical Association before recommending medical marijuana. In Pennsylvania, a four-hour training course is required for participating practitioners under Act 16 of 2016. Update cycles are also different. Pennsylvania patients renew their certification annually. Florida patients renew their state ID cards annually, but because they are required to certify a new physician every 30 weeks (approximately seven months), most Florida patients see a qualified physician twice a year instead of once.
The cost structures are similar, but not identical. Pennsylvania has a $50 annual state registration fee (exempted for patients enrolled in Medicaid, SNAP, WIC, or PACE). Florida charges a $75 annual state ID fee. A doctor’s visit in Pennsylvania typically costs $99 to $199, while a doctor’s visit in Florida ranges from $150 to $300, in part because recertification occurs more frequently. Because cannabis remains a federal Schedule I controlled substance, neither state’s medical products are covered by health insurance. The certification process itself has largely moved toward telemedicine in programs in Pennsylvania and other states, with a network of licensed cannabis physicians handling patient evaluations, qualifying condition reviews, and certifications all through video consultations.
What a comparison tells us about Florida’s approach
In a direct comparison, Florida State’s program is more accessible. Florida has a high patient volume, many clinics, a wide variety of products, low prices, and a short eligibility list with comprehensive provisions that give physicians flexibility. Pennsylvania’s program has stricter restrictions on smoking and edibles, is more conservative in terms of patient growth, has a higher price per gram but generates similar or higher total revenue, and has a legally more detailed list of eligibility conditions.
Both states are in the midst of debate over future policies. Florida rejected the Third Amendment in November 2024, leaving the medical program as the only legal access route for the time being. Pennsylvania Governor Shapiro has proposed adult-use legalization in three consecutive budget speeches, and the House bill (HB 1200) passed the Pennsylvania House of Representatives in May 2025 and was subsequently defeated in the Senate. Whether either state moves toward recreational legalization over the next two years will depend more on political dynamics than on the performance of the medical programs themselves.
The question for Floridians evaluating Florida’s approach is not whether the program is perfect (it is not), but whether it can provide broader access at lower costs than comparable programs in other large states. That’s what the data says. Florida has a larger registered patient base than any other state in the country, more product types available, and lower prices per gram than Pennsylvania. Whatever shortcomings exist in the regulatory framework, this program has created one of the most accessible medical cannabis systems in the United States.
