2/14/2024
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Posted by Provider Relations
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Provider News
The Medicaid Drug Rebate Program (MDRP), established by the Omnibus Budget Reconciliation Act of 1990 (OBRA '90), requires that drug manufacturers to enter into an agreement with the Centers for Medicare and Medicaid Services (CMS) to provide rebates for drugs covered by Medicaid. Reimbursement for practitioner-administered drugs is only allowed if the drug qualifies for rebate in accordance with 42 USC 1396r-8.
Providers are encouraged to use the tools below to determine if a practitioner-administered drug will be reimbursable through Fidelis Care Medicaid and HARP plans. Claims submitted with NDC numbers that are not on the list of approved manufacturers will deny. Exceptions to this program include vaccines, radiopharmaceuticals, and contrast media.
Participating Drug Companies For Medicaid Drug Rebate Program
The list linked below of participating drug companies provides a tool for practitioners to identify drug labelers/vendors that participate in the Medicaid Drug Rebate Program. Please note that the first 5 digits of the National Drug Code (NDC) represent the labeler/vendor. If the labeler code is not on this list, the labeler's drug is not reimbursable by Medicaid. Please refer to this list periodically, as the list of covered labelers/vendors is continually being updated.
Click here for the list of Medicaid Drug Rebate Program Participating Drug Companies
Practitioner Administered Drug (PAD) Search Tool
The Practitioner Administered Drug (PAD) Search Tool is a list of practitioner-administered drugs that can be billed to the medical benefit using an appropriate Healthcare Common Procedure Coding System (HCPCS) code and National Drug Code (NDC). Practitioner-administered drugs are drugs, other than vaccines, that are covered under section 1927(k)(2) of the Social Security Act, and are typically administered by a medical professional in a practitioner's office or other outpatient clinical setting.
If you have any questions, please contact your Fidelis Care Provider Relations Specialist. To find your designated representative, please visit Contact Your Designated Provider Relations Specialist.