Background: The World Health Organization recommends that national healthcare policies include evidence-based lists of essential medicines to allow equitable availability of drugs that are appropriate for the populations served. Use of Cochrane reviews to develop the Essential Medicines List has been increasing. While the United States has no national health plan, state-administered Medicaid plans provide medical care and drug coverage to the poor. Some states use systematic reviews from the Drug Effectiveness Review Program (DERP) to develop drug formularies for their Medicaid programs. The 13 DERP member states’ populations have a combined Medicaid enrollment of over 11 million, more than 25% of the US total. Objectives: In order to assess whether or not systematic reviews provide adequate evidence for the development of Medicaid drug formularies, we examine racial/ethnic and income concordance between Medicaid enrollees and populations included in systematic reviews. Methods: We examine DERP reviews to assess the inclusion and analysis of racial/ethnic and low-income populations. We also examine the review process itself, as implemented by both DERP and Cochrane. Results: In DERP states, Whites comprise the single largest group of Medicaid recipients (33% to 79%), but racial/ethnic minorities are overrepresented (21% to 57%) compared to the general population (10% to 30%). About 10% of Whites receive Medicaid, compared with over 20% of Blacks and Hispanics. Both DERP and Cochrane evaluate the evidence for inclusion and analysis of racial/ethnic subgroups, but not low-income populations. In the most DERP reviews, there is insufficient evidence in the component trials to evaluate differential effects of pharmaceuticals by race or ethnicity. Conclusions: In DERP states alone, over two million Blacks and Hispanics depend on Medicaid for health care. Race and poverty have been associated with health inequities in the US and elsewhere. Drug trials have been criticized for their focus on white patients. In order to provide evidence for drug efficacy and safety for Medicaid and other programs that serve disadvantaged populations, drug trials should enroll and analyze results for more members of nonwhite and low-income populations, and SRs should include low-income individuals in subgroup analyses.