Florida and Pennsylvania run the two largest medical-only cannabis programs in the United States. Both states have refused to legalize recreational adult use through legislative or ballot action. Both built their medical infrastructure from scratch in the second half of the 2010s. And both now serve hundreds of thousands of patients through dispensary networks, generating more than a billion dollars a year. Once you look past those surface similarities, though, the two programs operate very differently. Comparing them is a useful way to evaluate how Florida’s regulatory approach is performing.
Patient Numbers
Florida’s program is the largest medical-only cannabis program in the country by a wide margin. As of December 2025, the state’s Office of Medical Marijuana Use reported 930,779 registered patients, served by 737 licensed dispensaries. Pennsylvania’s program had 439,400 registered patients as of November 2025, served by 185 licensed dispensaries.
Florida’s population (about 23 million) is larger than Pennsylvania’s (about 13 million), but not by a factor that explains the patient gap. Adjusted per capita, Florida has roughly 4 percent of its residents enrolled in the medical cannabis program. Pennsylvania has roughly 3.4 percent. Florida is reaching a noticeably larger share of its population.
Both states have seen growth slow in 2025. Pennsylvania actually lost about 1,300 net patients between November 2024 and November 2025, an unusual reversal for a program that had grown every year since launch. Florida added roughly 35,000 patients across 11 months of 2025, down sharply from the program’s earlier growth rates. That deceleration in both states is what tends to happen as medical-only programs reach maturity: the population that wants access has largely obtained it.
Sales Volumes
Despite Florida having more than twice as many patients as Pennsylvania, the two states’ annual sales are closer than the patient numbers would suggest. Florida’s medical cannabis market generated roughly $1.65 billion in retail sales in 2025. Pennsylvania’s market topped $1.3 billion through the first three quarters of 2025 and finished the year at approximately $1.8 billion, slightly higher than Florida’s total.
The reason is product mix and pricing. Pennsylvania patients spend more per capita than Florida patients. Pennsylvania’s average retail flower price ($7.59 per gram in 2025, down from $14.90 in 2021) is in line with mature competitive markets, while the program’s regulatory restrictions push patients toward higher-margin products. Florida’s pricing is generally lower, and patient spend per capita reflects that. The short version: Florida moves more units to more patients at lower price points; Pennsylvania moves fewer units to fewer patients at higher per-patient revenue.
Cumulative sales reinforce the point. Pennsylvania’s medical program generated approximately $8.5 billion in retail sales between February 2018 and the end of 2025, making it the sixth-largest cannabis retail market in the country, even though the program is medical-only and even though five neighboring states (New Jersey, New York, Maryland, Delaware, and Ohio) have legalized adult use.
Where the Programs Diverge Most
Florida and Pennsylvania allow patients to access broadly similar medical cannabis products, but the differences in what is permitted matter.
Florida allows smokable flower since the state legalized smoking medical cannabis in 2019 after Governor Ron DeSantis signed legislation lifting the previous ban. Pennsylvania currently does not. Pennsylvania patients can purchase dry-leaf flower, but state law permits it only for vaporization, not for smoking. The Medical Marijuana Act prohibits combustion entirely.
Pennsylvania also prohibits traditional cannabis edibles. No gummies, no chocolates, no infused cookies are sold in Pennsylvania medical dispensaries. Patients seeking oral dosing receive pills, capsules, tinctures, or recently approved troches and lozenges that dissolve in the mouth.
Both restrictions were deliberate policy choices, originally framed around preventing diversion to minors and around concerns about combustion-related health effects. The trade-off matters for Pennsylvania patients. For someone who finds vaporization unsatisfying, who cannot easily use tinctures, and who wants the predictable dosing of an edible, Florida offers options that Pennsylvania does not. For policymakers concerned about youth-appealing product formats and combustion health risks, Pennsylvania’s approach has held the line longer.
Possession limits also differ. Florida assigns specific milligram THC caps per route of administration, set on a per-patient basis by the qualifying physician. Pennsylvania allows up to a 90-day supply per certification (defined statutorily as 192 medical marijuana units), with the actual amount determined by the physician.
Qualifying Conditions: Florida Is Slightly More Permissive
Florida’s qualifying conditions list (under Section 381.986, Florida Statutes) covers cancer, epilepsy, glaucoma, HIV/AIDS, PTSD, ALS, Crohn’s disease, Parkinson’s disease, multiple sclerosis, terminal conditions, chronic nonmalignant pain caused by a qualifying condition, and a catchall for “other debilitating medical conditions of the same kind or class as or comparable to” the listed conditions. The catchall provision gives Florida physicians some discretion.
Pennsylvania has 24 specifically enumerated serious medical conditions, including most of the conditions Florida lists, plus a few that Florida does not (anxiety disorders, Tourette syndrome, opioid use disorder when conventional therapeutic interventions are ineffective). Pennsylvania’s list is more explicit but less flexible. There is no equivalent catchall in Pennsylvania’s statute.
The practical effect is that physicians in both states certify patients for largely overlapping conditions, but Pennsylvania’s inclusion of anxiety as a qualifying condition (added in 2019) and its inclusion of 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 more expansive view of what medical cannabis can treat. Florida physicians can sometimes get to similar outcomes through the catchall, but the documentation is more complex. Across state medical programs more broadly, patients can verify whether their specific diagnosis is recognized as a qualifying condition before scheduling a certification visit.
Telehealth and Certification Process
Both states permit telehealth-based certifications, but with meaningful differences. Pennsylvania allows the entire certification process (initial and renewal) to take place by video consultation. Florida requires the initial certification to be conducted in person; only follow-up renewals (since House Bill 387 in 2023) can be done by telehealth. Florida requires qualified physicians to complete a state-mandated 2-hour course administered by the Florida Medical Association before they can recommend medical cannabis. Pennsylvania requires a 4-hour training course for participating practitioners under Act 16 of 2016. The renewal cycles are different, too. Pennsylvania patients renew their certification annually. Florida patients renew their state ID card annually but must obtain a new physician certification every 30 weeks (about seven months), so most Florida patients see a qualified physician twice a year rather than once.
The cost structure is broadly comparable but not identical. Pennsylvania charges a $50 annual state registration fee (waivable for patients enrolled in Medicaid, SNAP, WIC, or PACE). Florida charges a $75 annual state ID fee. Physician consultation fees in Pennsylvania typically run $99 to $199, while Florida consultations run $150 to $300, partly because of the more frequent recertifications. Neither state’s medical product is covered by health insurance, because cannabis remains a federal Schedule I controlled substance. The certification process itself has shifted heavily toward telehealth in Pennsylvania and other state programs, where networks of licensed cannabis doctors handle patient evaluations, qualifying condition reviews, and certifications entirely through video consultation.
What the Comparison Says About Florida’s Approach
Compared head to head, Florida’s program is the more accessible of the two. Florida has more patients, more dispensaries, more product types, lower prices, and a shorter qualifying conditions list with a catchall provision that gives physicians flexibility. Pennsylvania’s program is more restrictive on smoking and edibles, more conservative on patient growth, and more expensive per gram, but generates comparable or higher total revenue and has a more legislatively detailed qualifying conditions list.
Both states are in the middle of policy debates over what comes next. Florida defeated Amendment 3 in November 2024, leaving the medical program as the only legal access route for the foreseeable future. Pennsylvania’s Governor Shapiro has proposed adult-use legalization in three consecutive budget addresses, and a House bill (HB 1200) passed the Pennsylvania House in May 2025 before being killed in the Senate. Whether either state moves toward recreational legalization in the next two years will depend more on political dynamics than on the performance of the medical programs themselves.
For Floridians evaluating their state’s approach, the question is not whether the program is perfect (it is not), but whether it delivers broader access at lower cost than the comparable program in another large state. On the data, it does. Florida has a larger registered patient base than any other state in the country, more product types available than Pennsylvania, and lower per-gram pricing. Whatever shortcomings exist in the regulatory framework, the program has produced one of the most accessible medical cannabis systems in the United States.
