Medicaid Drug Rebate Program

Labeler Reference for NDCs included under the Medicaid Drug Rebate Program

Labeler CodeLabeler NameEffective DateNotes
00002ELI LILLY AND COMPANY1991-01-01 00:00:00
00003E.R. SQUIBB & SONS, LLC.1991-01-01 00:00:00
00004GENENTECH, INC.1991-01-01 00:00:00
00006MERCK SHARP & DOHME CORP.1991-01-01 00:00:00
00007GLAXOSMITHKLINE LLC1991-01-01 00:00:00
00008WYETH PHARMACEUTICALS LLC,1991-01-01 00:00:00
00009PHARMACIA AND UPJOHN COMPANY LLC1991-01-01 00:00:00
00013PFIZER LABORATORIES DIV PFIZER INC1991-01-01 00:00:00
00015MEAD JOHNSON AND COMPANY1991-01-01 00:00:00
00023ALLERGAN INC1991-01-01 00:00:00
00024SANOFI-AVENTIS, US LLC1991-01-01 00:00:00
00025PFIZER LABORATORIES DIV PFIZER INC1991-01-01 00:00:00
00026BAYER HEALTHCARE LLC1991-01-01 00:00:00
00032ABBVIE INC.1991-01-01 00:00:00
00037MEDA PHARMACEUTICALS, INC.1991-01-01 00:00:00
00039SANOFI-AVENTIS, US LLC1991-01-01 00:00:00
00046WYETH PHARMACEUTICALS INC.1991-01-01 00:00:00
00049ROERIG1991-01-01 00:00:00
00051ABBVIE INC1997-10-01 00:00:00
00052MERCK SHARP & DOHME CORP1991-01-01 00:00:00
00053CSL BEHRING L.L.C.1991-01-01 00:00:00
00054HIKMA PHARMACEUTICALS USA INC.1991-01-01 00:00:00
00056BRISTOL-MYERS SQUIBB PHARMA CO.1991-01-01 00:00:00
00065ALCON LABORATORIES, INC.1991-01-01 00:00:00
00068SANOFI-AVENTIS U.S. LLC1991-01-01 00:00:00
00069PFIZER LABORATORIES DIV PFIZER INC1991-01-01 00:00:00
00071PARKE-DAVIS DIV OF PFIZER1991-01-01 00:00:00
00074ABBVIE INC1991-01-01 00:00:00
00075SANOFI-AVENTIS U.S. LLC1991-01-01 00:00:00
00078NOVARTIS PHARMACEUTICALS CORPORATION1991-01-01 00:00:00
00085MERCK SHARP & DOHME CORP.1991-01-01 00:00:00
00087BRISTOL-MYERS SQUIBB COMPANY1991-01-01 00:00:00
00088SANOFI-AVENTIS U.S.LLC1991-01-01 00:00:00
00093TEVA PHARMACEUTICALS USA, INC.1991-01-01 00:00:00
00095BAUSCH HEALTH US, LLC1991-10-01 00:00:00
00096PERSON & COVEY, INC.1999-04-01 00:00:00
00113L. PERRIGO COMPANY2003-04-30 00:00:00
00115AMNEAL PHARMACEUTICALS OF NEW YORK LLC1991-01-01 00:00:00
00116XTTRIUM LABORATORIES, INC.2001-08-17 00:00:00
00121PAI1991-01-01 00:00:00
00131UCB, INC.1991-01-01 00:00:00
00132C B FLEET COMPANY INC1991-01-01 00:00:00
00143HIKMA PHARMACEUTICALS USA INC.1991-01-01 00:00:00
00145STIEFEL LABORATORIES, INC,1991-01-01 00:00:00
00168E FOUGERA AND CO.1991-01-01 00:00:00
00169NOVO NORDISK, INC.1991-01-01 00:00:00
00172TEVA PHARMACEUTICALS USA, INC1991-01-01 00:00:00
00173GLAXOSMITHKLINE1991-01-01 00:00:00
00178MISSION PHARMACAL COMPANY1991-01-01 00:00:00
00185EON LABS, INC.1991-01-01 00:00:00
00186ASTRAZENECA PHARMACEUTICALS LP1991-01-01 00:00:00
00187BAUSCH HEALTH US, LLC.1991-01-01 00:00:00
00206WYETH PHARMACEUTICALS LLC,1991-01-01 00:00:00
00224KONSYL PHARMACEUTICALS, INC.1992-01-01 00:00:00
00225B. F. ASCHER AND COMPANY, INC.1991-01-01 00:00:00
00228ACTAVIS PHARMA, INC.1991-01-01 00:00:00
00245UPSHER-SMITH LABORATORIES, INC.1991-01-01 00:00:00
00254PAR PHARMACEUTICAL INC.2018-09-28 00:00:00
00259MERZ PHARMACEUTICALS1991-01-01 00:00:00
00264B. BRAUN MEDICAL INC.1991-01-01 00:00:00
00281SAVAGE LABORATORIES1991-01-01 00:00:00
00299GALDERMA LABORATORIES, L.P.1991-01-01 00:00:00
00310ASTRAZENECA PHARMACEUTICALS LP1991-01-01 00:00:00
00338BAXTER HEALTHCARE CORPORATION1991-01-01 00:00:00
00378MYLAN PHARMACEUTICALS, INC.1991-01-01 00:00:00
00406SPEC GX, LLC1991-10-01 00:00:00
00407GE HEALTHCARE, INC.2011-07-05 00:00:00
00409HOSPIRA, INC.2004-10-28 00:00:00
00430ALLERGAN, INC.1998-01-01 00:00:00
00456ALLERGAN, INC.1991-01-01 00:00:00
00469ASTELLAS PHARMA US, INC.1991-01-01 00:00:00
00472ACTAVIS PHARMA, INC.1991-01-01 00:00:00
00485EDWARDS PHARMACEUTICALS, INC.1991-01-01 00:00:00
00486BEACH PHARMACEUTICALS1991-01-01 00:00:00
00487NEPHRON PHARMACEUTICALS CORPORATION1992-04-01 00:00:00
00517AMERICAN REGENT, INC.1991-10-01 00:00:00
00527LANNETT COMPANY, INC.1994-07-01 00:00:00
00536RUGBY LABORATORIES1991-01-01 00:00:00
00548AMPHASTAR PHARMACEUTICALS, INC.2012-10-22 00:00:00
00555TEVA PHARMACEUTICALS USA, INC1991-01-01 00:00:00
00562KEDRION MELVILLE, INC.2013-01-18 00:00:00
00574PADAGIS US LLC1991-01-01 00:00:00
00575TEVA PHARMACEUTICALS USA, INC1991-10-01 00:00:00
00591ACTAVIS PHARMA, INC.2001-03-29 00:00:00
00597BOEHRINGER INGELHEIM PHARMACEUTICALS1991-01-01 00:00:00
00603PAR PHARMACEUTICAL1991-01-01 00:00:00
00641HIKMA PHARMACEUTICALS USA INC.1991-01-01 00:00:00
00642EXELTIS USA, INC.1991-01-01 00:00:00
00682MARNEL PHARMACEUTICALS, LLC1991-01-01 00:00:00
00703TEVA PARENTERAL MEDICINES INC1992-07-01 00:00:00
00713COSETTE PHARMACEUTICALS, INC.1991-07-01 00:00:00
00777DISTA PRODUCTS COMPANY1991-01-01 00:00:00
00781SANDOZ1991-01-01 00:00:00
00813PHARMICS INC.1991-01-01 00:00:00
00832UPSHER-SMITH LABORATORIES, LLC.1991-01-01 00:00:00
00884PEDINOL PHARMACAL INC1991-01-01 00:00:00
00904MAJOR PHARMACEUTICALS1991-01-01 00:00:00
00941BAXTER HEALTHCARE CORPORATION2010-04-01 00:00:00
00944BAXALTA US INC.1991-01-01 00:00:00
00955WINTHROP U.S.1996-01-01 00:00:00
00990ICU MEDICAL INC.2018-07-12 00:00:00
00998ALCON LABORATORIES, INC.1991-01-01 00:00:00
10019BAXTER HEALTHCARE CORPORATION2001-06-28 00:00:00
10094AQUESTIVE THERAPEUTICS2018-12-05 00:00:00
10122CHIESI USA, INC.2005-04-26 00:00:00
10144ACORDA THERAPEUTICS, INC.2005-05-27 00:00:00
10147PATRIOT PHARMACEUTICALS, LLC.2005-01-13 00:00:00
10148COTHERIX, INC.2018-09-06 00:00:00
10337PHARMADERM (DIVISION OF FOUGERA PHARMA)2002-04-16 00:00:00
10370PAR PHARMACEUTICALS, INC.2007-05-14 00:00:00
10454SOLSTICE NEUROSCIENCES, LLC.2005-10-18 00:00:00
10542HILLESTAD PHARMACEUTICALS USA1994-04-01 00:00:00
10572AFFORDABLE PHARMACEUTICALS, LLC2004-11-01 00:00:00
10599INTERSECT ENT, INC.2018-02-12 00:00:00
10631SUN PHARMACEUTICALS INDUSTRIES, INC.2005-07-20 00:00:00
10702KVK-TECH, INC.2006-10-10 00:00:00
10885GALEN US INCORPORATED2013-11-22 00:00:00
10922INTENDIS, INC.2005-08-01 00:00:00
11527SHEFFIELD PHARMACEUTICALS2020-04-28 00:00:00
11534SUNRISE PHARMACEUTICAL, INC.2015-10-12 00:00:00
11980ALLERGAN INC1991-01-01 00:00:00
11994LANTHEUS MEDICAL IMAGING, INC.2010-10-06 00:00:00
12496INDIVOR INC.1994-01-01 00:00:00
12830R.A. MCNEIL COMPANY1991-01-01 00:00:00
13107AUROBINDO PHARMA USA, INC.2005-06-02 00:00:00
13517E5 PHARMA, LLC2017-01-30 00:00:00
13533GRIFOLS USA, LLC2005-07-21 00:00:00
13548BAUSCH HEALTH US, LLC2006-04-01 00:00:00
13668TORRENT PHARMACEUTICALS LIMITED2007-07-02 00:00:00
13811TRIGEN LABORATORIES, LLC2006-01-09 00:00:00
13845PARSOLEX GMP CENTER, INC.2009-04-30 00:00:00
13913ASSERTIO THERAPEUTICS, INC.2005-07-27 00:00:00
13925SETON PHARMACEUTICALS, LLC2008-11-18 00:00:00
14539HERITAGE PHARMACEUTICALS, INC.2019-07-29 00:00:00
14789NEXUS PHARMACEUTICALS, INC.2018-01-09 00:00:00
15054IPSEN BIOPHARMACEUTICALS2006-01-26 00:00:00
15370CARWIN PHARMACEUTICAL ASSOCIATES, LLC.2006-06-16 00:00:00
15584GILEAD SCIENCES, LLC.2006-07-01 00:00:00
16252ACTAVIS PHARMA, INC.2006-06-01 00:00:00
16571RISING PHARMACEUTICALS, INC2006-01-17 00:00:00
16714NORTHSTAR RX LLC2008-01-15 00:00:00
16729ACCORD HEALTHCARE INC.2008-03-10 00:00:00
16781BAUSCH HEALTH US, LLC2018-09-12 00:00:00
17433ENEMEEZ, INC. DBA SUMMIT PHARMACEUTICAL2006-12-13 00:00:00
17478AKORN INC1991-01-01 00:00:00
17772SUPERNUS PHARMACEUTICALS, INC.2013-01-24 00:00:00
18657HALOZYME THERAPEUTICS, INC.2012-02-03 00:00:00
18860JAZZ PHARMACEUTICALS, INC2006-10-10 00:00:00
20536TALON THERAPEUTICS, INC2013-09-03 00:00:00
21724INDEPENDENCE PHARMACEUTICALS, LLC2014-05-28 00:00:00
21922ENCUBE ETHICALS PVT. LTD.2019-09-05 00:00:00
23155HERITAGE PHARMACEUTICALS, INC.2006-11-09 00:00:00
23359CENTURION LABS, LLC2010-01-06 00:00:00
23594AYTU THERAPEUTICS, LLC2014-04-24 00:00:00
23635SPEC GX, LLC.2007-02-05 00:00:00
24201LEUCADIA PHARMACEUTICALS2018-01-30 00:00:00
24208BAUSCH & LOMB INC.1991-01-01 00:00:00
24338ARBOR PHARMACEUTICALS, LLC.2007-08-01 00:00:00
24385AMERISOURCE BERGEN1991-10-01 00:00:00
24478NEXTWAVE PHARMACEUTICALS, INC.2007-06-07 00:00:00
24492PARI RESPIRATORY EQUIPMENT, INC.2015-01-22 00:00:00
24510COLLEGIUM PHARMACEUTICAL, INC.2016-05-26 00:00:00
24658PURACAP LAB. DBA BLU PHARMACEUTICALS2011-12-11 00:00:00
24689APNAR PHARMA LP2020-12-28 00:00:00
24979TWI PHARMACEUTICALS, INC.2015-01-29 00:00:00
25010BAUSCH HEALTH US, LLC2007-10-22 00:00:00
25021SAGENT PHARMACEUTICALS, INC.2008-08-06 00:00:00
25208MEDICURE INTERNATIONAL, INC.2008-05-15 00:00:00
25682ALEXION PHARMACEUTICALS2007-04-11 00:00:00
27241AJANTA PHARMA LIMITED2014-04-29 00:00:00
27437LUPIN PHARMACEUTICALS, INC.2007-03-31 00:00:00
27505MDD US OPERATIONS, LLC.2012-08-01 00:00:00
27808TRIS PHARMA, INC.2010-11-30 00:00:00
28595ALLEGIS PHARMACEUTICALS LLC2007-07-05 00:00:00
29033NOSTRUM LABORATORIES2007-04-24 00:00:00
29300UNICHEM PHARMACEUTICALS (USA), INC.2008-08-25 00:00:00
29978CAPITAL PHARMACEUTICAL, LLC2009-03-25 00:00:00
30237DENDREON PHARMACEUTICALS LLC2010-07-30 00:00:00
30698VALIDUS PHARMACEUTICALS, LLC.2007-07-05 00:00:00
31722CAMBER PHARMACEUTICALS, INC.2007-10-03 00:00:00
33342MACLEODS PHARMACEUTICALS LIMITED2012-07-12 00:00:00
35573BUREL PHARMACEUTICALS2011-03-21 00:00:00
36000BAXTER HEALTHCARE CORPORATION2018-06-01 00:00:00
37205CARDINAL HEALTH1994-10-01 00:00:00
39328PATRIN PHARMA, INC.2016-06-27 00:00:00
39822XGEN PHARMACEUTICALS DJB, INC.2000-04-13 00:00:00
40076PRESTIUM PHARMA, INC.2012-11-29 00:00:00
40085RENAISSANCE PHARMA, INC.2013-07-12 00:00:00
41616SUN PHARMA GLOBAL, INC.2008-10-27 00:00:00
42023PAR PHARMACEUTICAL, INC.2008-01-17 00:00:00
42043ORCHIDPHARMA, INC.2008-01-10 00:00:00
42192ACELLA PHARMACEUTICALS, LLC2018-09-28 00:00:00
42195XSPIRE PHARMA LLC2012-09-19 00:00:00
42211IROKO PHARMACEUTICALS LLC2009-01-27 00:00:00
42227VIROPHARMA BIOLOGICS, INC.2009-01-01 00:00:00
42292MYLAN INSTITUTIONAL INC.2015-07-24 00:00:00
42358SENTYNL THERAPEUTICS, INC.2015-06-17 00:00:00
42367EAGLE PHARMACEUTICALS, INC.2014-07-28 00:00:00
42385LAURUS LABS PRIVATE LIMITED2018-04-27 00:00:00
42388EXELIXIS, INC.2013-02-12 00:00:00
42457EMMAUS MEDICAL, INC.2008-08-12 00:00:00
42494CAMERON PHARMACEUTICALS, LLC.2016-09-07 00:00:00
42543VENSUN PHARMACEUTICALS, INC.2014-08-13 00:00:00
42571MICRO LABS LIMITED2013-04-29 00:00:00
42658HISUN PHARMACEUTICALS USA, INC.2019-08-05 00:00:00
42667ACERUS PHARMACEUTICALS CORPORATION2020-08-31 00:00:00
42702PARAGON BIOTECK, INC.2013-07-16 00:00:00
42747KYOWA KIRIN, INC,2008-12-24 00:00:00
42794SIGMAPHARM LABORATORIES, LLC2012-01-27 00:00:00
42799EDENBRIDGE PHARMACEUTICALS LLC2009-12-16 00:00:00
42806EPIC PHARMA LLC2010-01-26 00:00:00
42847CURRAX PHARMACEUTICALS, LLC.2010-10-14 00:00:00
42858RHODES PHARMACEUTICALS L.P.2009-12-02 00:00:00
42865ALLERGAN, INC.2009-10-19 00:00:00
42998MARATHON PHARMAEUTICALS, LLC2008-12-02 00:00:00
43066BAXTER HEALTHCARE CORPORATION2011-08-12 00:00:00
43068VANDA PHARMACEUTICALS, INC.2009-07-30 00:00:00
43199COUNTY LINE PHARMACEUTICALS, LLC2009-07-27 00:00:00
43376ZOGENIX, INC.2011-01-31 00:00:00
43386LUPIN PHARMACEUTICALS, INC.2009-06-09 00:00:00
43393GENBIOPRO, INC.2013-01-22 00:00:00
43485APRECIA PHARMACEUTICALS, LLC2016-04-25 00:00:00
43538MEDIMETRIKS PHARMACEUTICALS, INC.2008-12-30 00:00:00
43547SOLCO HEALTHCARE USA, LLC2009-05-12 00:00:00
43598DR. REDDY'S LABORATORIES, INC.2011-04-18 00:00:00
43975ANI PHARMACEUTICALS, INC.2014-02-11 00:00:00
44087EMD SERONO, INC.1991-10-01 00:00:00
44183CURRAX PHARMACEUTICALS, LLC.2009-05-30 00:00:00
44206CSL BEHRING AG2001-11-20 00:00:00
44523BIOCOMP PHARMA, INC.2009-01-20 00:00:00
44567WG CRITICAL CARE, LLC2009-04-28 00:00:00
45043MANCHESTER PHARMACEUTICALS CORPORATION2010-01-14 00:00:00
45629Aveo Pharmaceuticals, Inc2021-04-13 00:00:00
45802PADAGIS ISRAEL PHARMACEUTICALS LTD.1991-01-01 00:00:00
45945MALLINCKRODT, LLC2010-12-28 00:00:00
45963ACTAVIS PHARMA, INC.2009-10-15 00:00:00
46017MYLAN CONSUMER HEALTHCARE, INC.2018-11-09 00:00:00
46122AMERISOURCE BERGEN2010-07-05 00:00:00
46287CMP PHARMA, INC.1993-10-01 00:00:00
46672MIKART INC.1991-01-01 00:00:00
46783MERZ NORTH AMERICA, INC.2013-03-28 00:00:00
47335SUN PHARMACEUTICALS INDUSTRIES, INC.2009-12-30 00:00:00
47426HERON THERAPEUTICS, INC.2016-09-14 00:00:00
47781ALVOGEN INC.2010-01-29 00:00:00
47783DYAX CORP.2010-01-28 00:00:00
47918MANNKIND CORPORATION2016-10-20 00:00:00
48102FERA PHARMACEUTICALS, LLC2009-12-23 00:00:00
48818ALLOS THERAPEUTICS INC.2009-10-28 00:00:00
49230FRESENIUS MEDICAL CARE NORTH AMERICA2007-01-22 00:00:00
49348STRATEGIC SOURCING SERVICES LLC1991-01-01 00:00:00
49401GLAXOSMITHKLINE LLC2011-03-29 00:00:00
49411CLOVER PHARMACEUTICALS CORPORATION2015-08-27 00:00:00
49483TIME CAP LABORATORIES, INC.1992-10-01 00:00:00
49502MYLAN SPECIALTY L.P.1991-01-01 00:00:00
49702VIIV HEALTHCARE COMPANY2010-10-19 00:00:00
49708SUN PHARMACEUTICALS INDUSTRIES, INC.2010-01-04 00:00:00
49730HERCON PHARMACEUTICALS, LLC2014-10-06 00:00:00
49884PAR PHARMACEUTICAL1991-01-01 00:00:00
49909EDGEMONT PHARMACEUTICALS, LLC2012-01-12 00:00:00
49938JACOBUS PHARMACEUTICALS CO INC.1991-01-01 00:00:00
50102AFAXYS PHARMA, INC.2013-01-17 00:00:00
50111TEVA PHARMACEUTICALS USA, INC1991-01-01 00:00:00
50222LEO PHARMA INC.2010-02-23 00:00:00
50228SCIEGEN PHARMACEUTICALS, INC.2018-10-11 00:00:00
50242GENENTECH, INC.1991-01-01 00:00:00
50261THERAPEUTICSMD2019-10-23 00:00:00
50268AVPAK2017-09-25 00:00:00
50383HI-TECH PHARMACAL CO. INC.1991-01-01 00:00:00
50419BAYER HEALTHCARE PHARMACEUTICALS, INC1991-01-01 00:00:00
50458JANSSEN PHARMACEUTICALS, INC1991-01-01 00:00:00
50474UCB, INC.1991-01-01 00:00:00
50742INGENUS PHARMACEUTICALS, LLC2011-03-25 00:00:00
50844LNK INTERNATIONAL, INC.1996-10-01 00:00:00
50881INCYTE CORPORATION2011-12-08 00:00:00
50967WOMENS CHOICE PHARMACEUTICALS2011-05-13 00:00:00
50991POLY PHARMACEUTICALS, INC.1991-01-01 00:00:00
51021SIRCLE LABORATORIES, LLC2014-10-22 00:00:00
51079MYLAN INSTITUTIONAL, INC1991-01-01 00:00:00
51144SEAGAN INC.2011-09-26 00:00:00
51167VERTEX PHARMACEUTICALS, INC.2011-03-14 00:00:00
51224TAGI PHARMA, INC2011-04-07 00:00:00
51248ASTELLAS PHARMA US, INC.2005-01-14 00:00:00
51267NALPROPION PHARMACEUTICALS2017-01-19 00:00:00
51285TEVA WOMENS HEALTH INC1991-01-01 00:00:00
51293ECI PHARMACEUTICALS LLC2016-10-12 00:00:00
51525WALLACE PHARMACEUTICALS2010-07-20 00:00:00
51645GEMINI PHARMACEUTICALS, INC.2005-02-12 00:00:00
51660OHM PHARMACEUTICALS, INC.2005-04-25 00:00:00
51672TARO PHARMACEUTICALS USA, INC.1991-01-01 00:00:00
51754EXELA PHARMA SCIENCES2015-01-23 00:00:00
51759TEVA PHARMACEUTICALS USA, INC2013-10-29 00:00:00
51801NOMAX, INC.1995-07-01 00:00:00
51862MAYNE PHARMA INC.2011-06-15 00:00:00
51991BRECKENRIDGE PHARMACEUTICAL, INC.1991-01-01 00:00:00
52015MERCK SHARP & DOHME CORP.2011-06-22 00:00:00
52054AMEDRA PHARMACEUTICALS, LLC2010-07-20 00:00:00
52244ENDO PHARMACEUTICALS INC.2011-10-07 00:00:00
52246PARAPRO, LLC2011-01-18 00:00:00
52268BRAINTREE LABORATORIES INC.1991-01-01 00:00:00
52276RECORDATI RARE DISEASES2010-12-15 00:00:00
52427ALMATICA PHARMA, LLC.2011-08-09 00:00:00
52440TITAN PHARMACEUTICALS, INC.2019-01-08 00:00:00
52536WILSHIRE PHARMACEUTICALS, INC.2011-03-09 00:00:00
52544ACTAVIS PHARMA, INC.1991-01-01 00:00:00
52565TELIGENT PHARMA, INC.2012-12-21 00:00:00
52609APO-PHARMA USA, INC.2011-04-07 00:00:00
52652AZURITY PHARMACEUTICALS, INC.2013-08-28 00:00:00
52796BONGEO PHARMACEUTICALS, INC.2016-04-22 00:00:00
52817TRUPHARMA, LLC2016-07-19 00:00:00
52856PTC THERAPEUTICS, INC.2018-09-20 00:00:00
52937AMARIN PHARMACEUTICALS IRELAND LTD2013-01-16 00:00:00
53097THE PHARMA NETWORK, LLC2016-03-02 00:00:00
53436VIFOR PHARMA, INC.2015-10-30 00:00:00
53451ARBOR PHARMACEUTICALS2013-06-06 00:00:00
53489SUN PHARMACEUTICAL INDUSTRIES, INC.1991-01-01 00:00:00
53746AMNEAL PHARMACEUTICALS OF NEW YORK LLC1991-01-01 00:00:00
54092TAKEDA PHARMACEUTICALS AMERICA, INC.1993-04-01 00:00:00
54123OREXO US, INC.2013-07-24 00:00:00
54295TRINITY PHARMACEUTICALS LLC2016-10-12 00:00:00
54436ANTARES PHARMA, INC.2013-10-29 00:00:00
54458INTERNATIONAL LABORATORIES, LLC2008-03-05 00:00:00MDRP participation ends on 1/1/2022
54482LEADIANT BIOSCIENCES, INC.1991-01-01 00:00:00
54505LINEAGE THERAPEUTICS INC.2013-05-21 00:00:00
54643SANDOZ MANUFACTURING INC2000-11-17 00:00:00
54766SEBELA PHARMACEUTICALS, INC.2015-07-21 00:00:00
54838LANNETT COMPANY, INC.1991-01-01 00:00:00
54859LLORENS PHARMACEUTICALS INT'L DIVISION2001-07-18 00:00:00
54879STI PHARMA, LLC2012-05-25 00:00:00
54932BIORAMO, LLC.2020-05-07 00:00:00
55111DR. REDDY'S LABORATORIES, INC.2002-11-08 00:00:00
55135IMMUNOMEDICS, INC.2020-04-29 00:00:00
55150AUROMEDICS PHARMA LLC2012-09-13 00:00:00
55253CIMA LABS, INC.2007-04-01 00:00:00
55292RECORDATI RARE DISEASES, INC.2013-10-22 00:00:00
55466NEOLPHARMA, INC.2016-03-04 00:00:00
55494DUCHESNAY USA, INC.2013-04-12 00:00:00
55513AMGEN INC.1991-01-01 00:00:00
55566FERRING PHARMACEUTICALS, INC.1994-04-01 00:00:00
55670MOORE MEDICAL2020-05-01 00:00:00
55724PFIZER LABORATORIES DIV PFIZER INC.2014-10-06 00:00:00
57237RISING HEALTH, LLC.2013-06-26 00:00:00
57278ROCKWELL MEDICAL, INC.2015-12-07 00:00:00
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71981DOMPE FARMACEUTICI S.P.A.2019-02-04 00:00:00
72000NABRIVA THERAPEUTICS US, INC.2019-09-23 00:00:00
72028HARMONY BIOSCIENCES, LLC2019-11-06 00:00:00
72060INTRA-CELLULAR THERAPIES, INC.2020-03-19 00:00:00
72064BLUEPRINT MEDICINES CORPORATION2020-02-03 00:00:00
72065XERIS PHARMACEUTICALS, INC.2019-10-15 00:00:00
72078MYLAN INSTITUTIONAL LLC2021-01-12 00:00:00
72089EVOKE PHARMA INC.2021-01-28 00:00:00
72124CIRCASSIA PHARMACEUTICALS INC.2019-07-16 00:00:00
72126AKCEA THERAPEUTICS, INC.2018-10-31 00:00:00
72143JG PHARMA, INC.2021-10-21 00:00:00
72152SAGE THERAPEUTICS2019-06-26 00:00:00
72171NOVIMMUNE S.A.2019-01-11 00:00:00
72187STEMLINE THERAPEUTICS, INC.2019-01-28 00:00:00
72205NOVADOZ PHARMACEUTICALS, LLC2018-10-03 00:00:00
72237KARYOPHARM THERAPEUTICS2019-07-18 00:00:00
72252NEURELIS, INC.2020-03-05 00:00:00
72266FOSUN PHARMA USA2019-09-12 00:00:00
72305PROVELL PHARMACEUTICALS, LLC.2019-06-20 00:00:00
72356VYNE PHARMACEUTICALS INC.2020-01-17 00:00:00
72426ESPERION THERAPEUTICS, INC.2020-03-31 00:00:00
72485ARMAS PHARMACEUTICALS INC.2019-09-13 00:00:00
72493UROGEN PHARMA, INC.2020-06-16 00:00:00
72495MILLICENT U.S., INC.2019-01-23 00:00:00
72511AMGEN USA INC.2018-10-22 00:00:00
72512AVERITAS PHARMA, INC.2019-04-11 00:00:00
72516ORYZA PHARMACEUTICALS, INC.2021-03-02 00:00:00
72570DELSAM PHARMA LLC.2021-01-29 00:00:00MDRP participation ends on 1/1/2022
72572CIVICA, INC.2019-10-08 00:00:00
72578VIONA PHARMACEUTICALS INC.2019-06-07 00:00:00
72579BEIGENE USA, INC.2019-12-05 00:00:00
72603NORTHSTAR RX LLC2019-12-11 00:00:00
72606CELLTRION USA, INC.2019-06-12 00:00:00
72607EPIZYME, INC.2020-01-30 00:00:00
72611ALMAJECT, INC.2020-02-02 00:00:00
72618BIOHAVEN PHARMACEUTICALS, INC.2020-03-24 00:00:00
72626ASEGUA THERAPEUTICS LLC2019-01-02 00:00:00
72647OAKRUM PHARMA, LLC,2019-12-06 00:00:00
72664VGYAAN PHARMACEUTCIALS2021-07-15 00:00:00
72677VIELA BIO, INC.2020-07-27 00:00:00
72694SERVIER PHARMACEUTICALS LLC2019-10-30 00:00:00
72721HEARTWOOD PHARMA2019-05-23 00:00:00
72730QED Therapeutics, Inc.2021-07-06 00:00:00
72733SANOFI US CORPORATION2019-04-05 00:00:00
72763ESTRENO PHARMACEUTICALS LLC2021-02-23 00:00:00
72769BIOCRYST PHARMACEUTICALS, INC.2020-10-26 00:00:00
72786GLOBAL BLOOD THERAPEUTICS, INC.2019-12-27 00:00:00
72829RHYTHM PHARMACEUTICALS, INC.2021-03-01 00:00:00
72854RECKITT BENCKISER, INC.2021-09-22 00:00:00
72888ADVAGEN PHARMA LTD2021-03-03 00:00:00
72893ACROTECH BIOPHARMA LLC2020-02-04 00:00:00
72912ADLON THERAPEUTICS L.P.2019-07-23 00:00:00
72928Q BIOMED, INC.2020-04-17 00:00:00
72974MYOVANT SCIENCES, INC.2021-01-21 00:00:00
73042Y-MABS THERAPEUTICS, INC2021-02-11 00:00:00
73059SHIELD THERAPEUTICS2021-08-04 00:00:00
73070NOVO NORDISK PHARMA, INC.2020-01-06 00:00:00
73079EIGER BIOPHARMACEUTICALS INC.2021-02-04 00:00:00
73090EUSA PHARMA (US) LLC2021-01-13 00:00:00
73116SECURA BIO, INC.2021-10-07 00:00:00
73129ORIGIN BIOSCIENCES, INC.2021-04-15 00:00:00
73150TG THERAPEUTICS, INC.2021-02-25 00:00:00
73153JUNO THERAPEUTICS, INC.2021-03-16 00:00:00
73207DECIPHERA PHARMACEUTICALS, LLC2020-05-26 00:00:00
73292NS PHARMA, INC.2020-09-03 00:00:00
73302HRA PHARMA AMERICA, INC.2020-08-20 00:00:00
73317AUM PHARMACEUTICALS2021-07-27 00:00:00
73336UROVANT SCIENCES, INC.2021-04-07 00:00:00
73362Ascendis Pharma, Inc.2021-10-25 00:00:00
73372CLINUVEL, INC2021-10-22 00:00:00
73380INNATE PHARMA, INC.2020-10-15 00:00:00
73462G1 THERAPEUTICS INC.2021-03-09 00:00:00
73473SOLARIS PHARMA CORPORATION2020-09-14 00:00:00
73521OYSTER POINT PHARMA, INC.2021-11-08 00:00:00
73535MORPHOSYS US INC.2020-08-13 00:00:00
73556CHEMOCENTRYX, INC.2021-10-22 00:00:00
73562NESTLE HEALTHCARE NUTRITION, INC.2021-04-09 00:00:00
73594PHARMACOSMOS THERAPEUTICS INC2020-11-06 00:00:00
73604KINIKSA PHARMACEUTICALS (UK), LTD.2021-04-16 00:00:00
73606APL Sales I LLC2021-06-22 00:00:00
73607AMIVAS (US), LLC2021-08-04 00:00:00
73657ONCOPEPTIDES, INC.2021-04-05 00:00:00MDRP participation ends on 1/1/2022
74527MACROGENICS, INC.2021-03-11 00:00:00
74528ALBIREO PHARMA, INC.2021-07-30 00:00:00
74676VERITY PHARMACEUTICALS INC.2021-01-08 00:00:00
75626AURINIA PHARMA U.S. INC.2021-01-28 00:00:00
75788SCYNEXIS, INC.2021-07-21 00:00:00
75826WINDER LABORATORIES, LLC2017-10-27 00:00:00
75834NIVAGEN PHARMACEUTICALS INC.2014-06-04 00:00:00
75854AVION PHARMACEUTICALS2013-07-01 00:00:00
75987HORIZON THERAPEUTICS USA, INC.2011-09-06 00:00:00
76045FRESENIUS KABI USA, LLC2013-04-18 00:00:00
76075ONYX PHARMACEUTICAL2012-07-31 00:00:00
76125KEDRION BIOPHARMA, INC2011-12-05 00:00:00
76179KEDRION S.p.A.2012-01-26 00:00:00
76189ARIAD PHARMACEUTICALS, INC.2013-01-07 00:00:00MDRP participation ends on 1/1/2022
76204RITEDOSE PHARMACEUTICALS, LLC2011-12-14 00:00:00
76282EXELAN PHARMACEUTICALS, INC2011-12-02 00:00:00
76299MIST PHARMACEUTICALS, LLC2014-04-10 00:00:00
76329INTERNATIONAL MEDICATION SYSTEMS, LTD2012-04-19 00:00:00
76336HRA PHARMA AMERICA INC.2018-08-01 00:00:00
76346CORCEPT THERAPEUTICS INCORPORATED2012-04-11 00:00:00
76385BAYSHORE PHARMACEUTICALS LLC2013-10-30 00:00:00
76388ASPEN GLOBAL INCORPORATED2012-06-21 00:00:00
76431AMRYT PHARMACEUTICALS DAC2013-01-22 00:00:00
76439VIRTUS PHARMACEUTICALS, LLC2012-01-31 00:00:00
76478OAK PHARMACUETICALS, INC.2021-05-18 00:00:00
77530IMPEL NEUROPHARMA, INC.2021-10-08 00:00:00
78206ORGANON LLC2021-08-23 00:00:00
78670USWM, LLC2021-02-09 00:00:00
79378MIRUM PHARMACEUTICALS, INC.2021-10-07 00:00:00
79672NEXTGEN PHARMACEUTICALS LLC2020-11-25 00:00:00
79802KADMON PHARMACEUTICALS, LLC2021-08-11 00:00:00
79952ADC Therapeutics America, Inc.2021-05-11 00:00:00
80056INTRA-SANA LABORATORIES2021-04-21 00:00:00
80644ZEALAND PHARMA AS2021-04-27 00:00:00
80705TRIPOINT THERAPEUTICS2021-04-22 00:00:00
81561PORTON BIOPHARMA LIMITED2021-07-16 00:00:00
99207BAUSCH HEALTH US, LLC1991-10-01 00:00:00

Upper Peninsula Health Plan (UPHP) participates in the Medicaid Health Plan Common Formulary. Under the Common Formulary, Medicaid Health Plan formulary coverage is limited to products with a National Drug Code from manufacturers who participate in the Medicaid Drug Rebate Program. The following Medicaid Drug Rebate Program reference is reproduced from the Drug Manufacturer Contacts reference located on medicaid.gov.

A manufacturer’s labeler code is represented in the first five digits of a product’s NDC. Formulary NDCs included under a manufacturer’s labeler code are covered according to formulary coding established under the Common Formulary.

If a NDC for a non-MDRP participating labeler is adjudicated on a pharmacy claim, NCPDP error AC (Product Not Covered non-Participating Manufacturer) will be included in the reject messaging.

UPHP may consider making medical necessity accommodations for members who need a non-MDRP participating NDC when all formulary NDCs are unavailable. Prescribers must submit a Prior Authorization Request Form via fax to 888-656-3604. For urgent needs, pharmacies can call the MagellanRx Management Prior Authorization Help Desk for assistance at 248-540-6686.

Please note: This reference is up to date as of 11/26/2021 . Updates to the MDRP may occur multiple times each week. For a current list of additional updates, please visit the New/Reinstated & Terminated Labeler Information reference on the Medicaid.gov website.  Medicaid Health Plans apply the optional effective date for new/reinstated labelers. Labelers listed for termination are removed from coverage according to the effective date presented on the Terminated Labelers table.


Page Last Updated: 12/16/2021