Medicaid Drug Rebate Program

Labeler Reference for NDCs included under the Medicaid Drug Rebate Program

Labeler CodeLabeler NameEffective DateNotes
00002ELI LILLY AND COMPANY1/1/1991
00003E.R. SQUIBB & SONS, LLC.1/1/1991
00004GENENTECH, INC.1/1/1991
00006MERCK SHARP & DOHME LLC1/1/1991
00007GLAXOSMITHKLINE LLC1/1/1991
00008WYETH PHARMACEUTICALS LLC,1/1/1991
00009PHARMACIA AND UPJOHN COMPANY LLC1/1/1991
00013PFIZER LABORATORIES DIV PFIZER INC1/1/1991
00023ALLERGAN INC1/1/1991
00024SANOFI-AVENTIS, US LLC1/1/1991
00025PFIZER LABORATORIES DIV PFIZER INC1/1/1991
00026BAYER HEALTHCARE LLC1/1/1991
00032ABBVIE INC.1/1/1991
00037MEDA PHARMACEUTICALS, INC.1/1/1991
00039SANOFI-AVENTIS, US LLC1/1/1991
00046WYETH PHARMACEUTICALS INC.1/1/1991
00049ROERIG1/1/1991
00051ABBVIE INC10/1/1997
00052MERCK SHARP & DOHME LLC1/1/1991
00053CSL BEHRING L.L.C.1/1/1991
00054HIKMA PHARMACEUTICALS USA INC.1/1/1991
00056BRISTOL-MYERS SQUIBB PHARMA CO.1/1/1991
00065ALCON LABORATORIES, INC.1/1/1991
00068SANOFI-AVENTIS U.S. LLC1/1/1991
00069PFIZER LABORATORIES DIV PFIZER INC1/1/1991
00071PARKE-DAVIS DIV OF PFIZER1/1/1991
00074ABBVIE INC1/1/1991
00075SANOFI-AVENTIS U.S. LLC1/1/1991
00078NOVARTIS PHARMACEUTICALS CORPORATION1/1/1991
00085MERCK SHARP & DOHME LLC1/1/1991
00088SANOFI-AVENTIS U.S.LLC1/1/1991
00093TEVA PHARMACEUTICALS USA, INC.1/1/1991
00095BAUSCH HEALTH US, LLC10/1/1991
00096PERSON & COVEY, INC.4/1/1999
00113L. PERRIGO COMPANY4/30/2003
00115AMNEAL PHARMACEUTICALS OF NEW YORK LLC1/1/1991
00116XTTRIUM LABORATORIES, INC.8/17/2001
00121PAI1/1/1991
00131UCB, INC.1/1/1991
00132C B FLEET COMPANY INC1/1/1991
00143HIKMA PHARMACEUTICALS USA INC.1/1/1991
00168E FOUGERA AND CO.1/1/1991
00169NOVO NORDISK, INC.1/1/1991
00172TEVA PHARMACEUTICALS USA, INC1/1/1991
00173GLAXOSMITHKLINE1/1/1991
00178MISSION PHARMACAL COMPANY1/1/1991
00185EON LABS, INC.1/1/1991
00186ASTRAZENECA PHARMACEUTICALS LP1/1/1991
00187BAUSCH HEALTH US, LLC.1/1/1991
00206WYETH PHARMACEUTICALS LLC,1/1/1991
00224KONSYL PHARMACEUTICALS, INC.1/1/1992
00228ACTAVIS PHARMA, INC.1/1/1991
00245UPSHER-SMITH LABORATORIES, INC.1/1/1991
00254PAR PHARMACEUTICAL INC.9/28/2018
00259MERZ PHARMACEUTICALS1/1/1991
00264B. BRAUN MEDICAL INC.1/1/1991
00281SAVAGE LABORATORIES1/1/1991
00310ASTRAZENECA PHARMACEUTICALS LP1/1/1991
00338BAXTER HEALTHCARE CORPORATION1/1/1991
00378MYLAN PHARMACEUTICALS, INC.1/1/1991
00406SPEC GX, LLC10/1/1991
00407GE HEALTHCARE, INC.7/5/2011
00409HOSPIRA, INC.10/28/2004
00430ALLERGAN, INC.1/1/1998
00456ALLERGAN, INC.1/1/1991
00469ASTELLAS PHARMA US, INC.1/1/1991
00472ACTAVIS PHARMA, INC.1/1/1991
00480Teva Pharmaceuticals, Inc.3/1/2022
00485EDWARDS PHARMACEUTICALS, INC.1/1/1991
00486BEACH PHARMACEUTICALS1/1/1991
00487NEPHRON PHARMACEUTICALS CORPORATION4/1/1992
00517AMERICAN REGENT, INC.10/1/1991
00527LANNETT COMPANY, INC.7/1/1994
00536RUGBY LABORATORIES1/1/1991
00548AMPHASTAR PHARMACEUTICALS, INC.10/22/2012
00555TEVA PHARMACEUTICALS USA, INC1/1/1991
00562KEDRION MELVILLE, INC.1/18/2013
00574PADAGIS US LLC1/1/1991
00575TEVA PHARMACEUTICALS USA, INC10/1/1991
00591ACTAVIS PHARMA, INC.3/29/2001
00597BOEHRINGER INGELHEIM PHARMACEUTICALS1/1/1991
00603PAR PHARMACEUTICAL1/1/1991
00641HIKMA PHARMACEUTICALS USA INC.1/1/1991
00642EXELTIS USA, INC.1/1/1991
00682MARNEL PHARMACEUTICALS, LLC1/1/1991
00703TEVA PARENTERAL MEDICINES INC7/1/1992
00713COSETTE PHARMACEUTICALS, INC.7/1/1991
00777DISTA PRODUCTS COMPANY1/1/1991
00781SANDOZ1/1/1991
00832UPSHER-SMITH LABORATORIES, LLC.1/1/1991
00884PEDINOL PHARMACAL INC1/1/1991
00904MAJOR PHARMACEUTICALS1/1/1991
00941BAXTER HEALTHCARE CORPORATION4/1/2010
00944Takeda Pharmaceuticals America, Inc.1/1/1991
00955WINTHROP U.S.1/1/1996
00990ICU MEDICAL INC.7/12/2018
00998ALCON LABORATORIES, INC.1/1/1991
10019BAXTER HEALTHCARE CORPORATION6/28/2001
10094AQUESTIVE THERAPEUTICS12/5/2018
10122CHIESI USA, INC.4/26/2005
10144ACORDA THERAPEUTICS, INC.5/27/2005
10147PATRIOT PHARMACEUTICALS, LLC.1/13/2005
10148COTHERIX, INC.9/6/2018
10337PHARMADERM (DIVISION OF FOUGERA PHARMA)4/16/2002
10370PAR PHARMACEUTICALS, INC.5/14/2007
10454SOLSTICE NEUROSCIENCES, LLC.10/18/2005
10542HILLESTAD PHARMACEUTICALS USA4/1/1994
10572AFFORDABLE PHARMACEUTICALS, LLC11/1/2004
10599INTERSECT ENT, INC.2/12/2018
10631SUN PHARMACEUTICALS INDUSTRIES, INC.7/20/2005
10702KVK-TECH, INC.10/10/2006
10922INTENDIS, INC.8/1/2005
11527SHEFFIELD PHARMACEUTICALS4/28/2020
11534SUNRISE PHARMACEUTICAL, INC.10/12/2015
11980ALLERGAN INC1/1/1991
11994LANTHEUS MEDICAL IMAGING, INC.10/6/2010
12496INDIVOR INC.1/1/1994
12830R.A. MCNEIL COMPANY1/1/1991
13107AUROBINDO PHARMA USA, INC.6/2/2005
13517E5 PHARMA, LLC1/30/2017
13533GRIFOLS USA, LLC7/21/2005
13548BAUSCH HEALTH US, LLC4/1/2006
13668TORRENT PHARMACEUTICALS LIMITED7/2/2007
13811TRIGEN LABORATORIES, LLC1/9/2006
13925SETON PHARMACEUTICALS, LLC11/18/2008
14539HERITAGE PHARMACEUTICALS, INC.7/29/2019
14789NEXUS PHARMACEUTICALS, INC.1/9/2018
15054IPSEN BIOPHARMACEUTICALS1/26/2006
15370CARWIN PHARMACEUTICAL ASSOCIATES, LLC.6/16/2006
15584GILEAD SCIENCES, LLC.7/1/2006
16252ACTAVIS PHARMA, INC.6/1/2006
16571RISING PHARMACEUTICALS, INC1/17/2006
16714NORTHSTAR RX LLC1/15/2008
16729ACCORD HEALTHCARE INC.3/10/2008
16781BAUSCH HEALTH US, LLC9/12/2018
17433ENEMEEZ, INC. DBA SUMMIT PHARMACEUTICAL12/13/2006
17772SUPERNUS PHARMACEUTICALS, INC.1/24/2013
18657HALOZYME THERAPEUTICS, INC.2/3/2012
18860JAZZ PHARMACEUTICALS, INC10/10/2006MDRP participation ends on 4/1/2024
21724INDEPENDENCE PHARMACEUTICALS, LLC5/28/2014
21922ENCUBE ETHICALS PVT. LTD.9/5/2019
23155HERITAGE PHARMACEUTICALS, INC.11/9/2006
23359CENTURION LABS, LLC1/6/2010
23594AYTU THERAPEUTICS, LLC4/24/2014
23635SPEC GX, LLC.2/5/2007
24201Hikma Pharmaceuticals USA Inc1/30/2018
24208BAUSCH & LOMB INC.1/1/1991
24338AZURITY PHARMACEUTICALS INC.8/1/2007
24385AMERISOURCE BERGEN10/1/1991
24478NEXTWAVE PHARMACEUTICALS, INC.6/7/2007
24492PARI RESPIRATORY EQUIPMENT, INC.1/22/2015
24510COLLEGIUM PHARMACEUTICAL, INC.5/26/2016
24658PURACAP LAB. DBA BLU PHARMACEUTICALS12/11/2011
24979TWI PHARMACEUTICALS, INC.1/29/2015
25010BAUSCH HEALTH US, LLC10/22/2007
25021SAGENT PHARMACEUTICALS, INC.8/6/2008
25208MEDICURE INTERNATIONAL, INC.5/15/2008
25682ALEXION PHARMACEUTICALS4/11/2007
27241AJANTA PHARMA LIMITED4/29/2014
27437LUPIN PHARMACEUTICALS, INC.3/31/2007
27505MDD US OPERATIONS, LLC.8/1/2012
27808TRIS PHARMA, INC.11/30/2010
28595ALLEGIS PHARMACEUTICALS LLC7/5/2007
29033NOSTRUM LABORATORIES4/24/2007
29300UNICHEM PHARMACEUTICALS (USA), INC.8/25/2008
29978CAPITAL PHARMACEUTICAL, LLC3/25/2009
30237DENDREON PHARMACEUTICALS LLC7/30/2010
30698VALIDUS PHARMACEUTICALS, LLC.7/5/2007
31722CAMBER PHARMACEUTICALS, INC.10/3/2007
33342MACLEODS PHARMACEUTICALS LIMITED7/12/2012
35573BUREL PHARMACEUTICALS3/21/2011
36000BAXTER HEALTHCARE CORPORATION6/1/2018
37205CARDINAL HEALTH10/1/1994
39328PATRIN PHARMA, INC.6/27/2016
39822XGEN PHARMACEUTICALS DJB, INC.4/13/2000
41616SUN PHARMA GLOBAL, INC.10/27/2008
42023PAR PHARMACEUTICAL, INC.1/17/2008
42192ACELLA PHARMACEUTICALS, LLC9/28/2018
42195XSPIRE PHARMA LLC9/19/2012
42227Takeda Pharmaceuticals America, Inc.1/1/2009
42292MYLAN INSTITUTIONAL INC.7/24/2015
42358SENTYNL THERAPEUTICS, INC.6/17/2015
42367EAGLE PHARMACEUTICALS, INC.7/28/2014
42385LAURUS LABS PRIVATE LIMITED4/27/2018
42388EXELIXIS, INC.2/12/2013
42457EMMAUS MEDICAL, INC.8/12/2008
42494CAMERON PHARMACEUTICALS, LLC.9/7/2016
42543VENSUN PHARMACEUTICALS, INC.8/13/2014
42571MICRO LABS LIMITED4/29/2013
42658HISUN PHARMACEUTICALS USA, INC.8/5/2019
42667ACERUS PHARMACEUTICALS CORPORATION8/31/2020
42702PARAGON BIOTECK, INC.7/16/2013
42747KYOWA KIRIN, INC,12/24/2008
42794SIGMAPHARM LABORATORIES, LLC1/27/2012
42799EDENBRIDGE PHARMACEUTICALS LLC12/16/2009
42806EPIC PHARMA LLC1/26/2010
42858RHODES PHARMACEUTICALS L.P.8/12/2011
43066BAXTER HEALTHCARE CORPORATION7/30/2009
43068VANDA PHARMACEUTICALS, INC.7/27/2009
43199COUNTY LINE PHARMACEUTICALS, LLC1/31/2011
43376UCB, INC.6/9/2009
43386LUPIN PHARMACEUTICALS, INC.1/22/2013
43393GENBIOPRO, INC.4/25/2016
43485APRECIA PHARMACEUTICALS, LLC12/30/2008
43538MEDIMETRIKS PHARMACEUTICALS, INC.5/12/2009
43547SOLCO HEALTHCARE USA, LLC4/18/2011
43598DR. REDDY'S LABORATORIES, INC.2/11/2014
43975ANI PHARMACEUTICALS, INC.10/1/1991
44087EMD SERONO, INC.11/20/2001
44206CSL BEHRING AG1/20/2009
44523BIOCOMP PHARMA, INC.4/28/2009
44567WG CRITICAL CARE, LLC1/14/2010
45043MANCHESTER PHARMACEUTICALS CORPORATION4/13/2021
45629Aveo Pharmaceuticals, Inc1/1/1991
45802PADAGIS ISRAEL PHARMACEUTICALS LTD.10/15/2009
45963ACTAVIS PHARMA, INC.11/9/2018
46017MYLAN CONSUMER HEALTHCARE, INC.7/5/2010
46122AMERISOURCE BERGEN10/1/1993
46287CMP PHARMA, INC.1/1/1991
46672MIKART INC.3/28/2013
46783MERZ NORTH AMERICA, INC.12/30/2009
47335SUN PHARMACEUTICALS INDUSTRIES, INC.9/14/2016
47426HERON THERAPEUTICS, INC.1/29/2010
47781ALVOGEN INC.1/28/2010
47783Takeda Pharmaceuticals America, Inc.10/20/2016
47918MANNKIND CORPORATION12/23/2009
48102FERA PHARMACEUTICALS, LLC10/28/2009
48818Acrotech Biopharma LLC1/22/2007
49230FRESENIUS MEDICAL CARE NORTH AMERICA1/1/1991
49348STRATEGIC SOURCING SERVICES LLC3/29/2011
49401GLAXOSMITHKLINE LLC10/1/1992
49483TIME CAP LABORATORIES, INC.1/1/1991
49502MYLAN SPECIALTY L.P.10/11/2023
49591KAMADA LTD.10/31/2017
49702VIIV HEALTHCARE COMPANY1/4/2010
49708SUN PHARMACEUTICALS INDUSTRIES, INC.10/6/2014
49730HERCON PHARMACEUTICALS, LLC1/1/1991
49884PAR PHARMACEUTICAL1/12/2012
49909EDGEMONT PHARMACEUTICALS, LLC1/17/2013
50102AFAXYS PHARMA, INC.1/1/1991
50111TEVA PHARMACEUTICALS USA, INC2/23/2010
50222LEO PHARMA INC.10/11/2018
50228SCIEGEN PHARMACEUTICALS, INC.1/1/1991
50242GENENTECH, INC.10/23/2019
50261Mayne Pharma LLC9/25/2017
50268AVPAK1/1/1991
50419BAYER HEALTHCARE PHARMACEUTICALS, INC1/1/1991
50458JANSSEN PHARMACEUTICALS, INC1/1/1991
50474UCB, INC.3/25/2011
50742INGENUS PHARMACEUTICALS, LLC10/1/1996
50844LNK INTERNATIONAL, INC.12/8/2011
50881INCYTE CORPORATION5/13/2011
50967WOMENS CHOICE PHARMACEUTICALS1/1/1991
50991POLY PHARMACEUTICALS, INC.1/1/1991
51079MYLAN INSTITUTIONAL, INC5/30/2023
51097Alexza Pharmaceuticals Inc.9/26/2011
51144SEAGEN INC.3/14/2011
51167VERTEX PHARMACEUTICALS, INC.4/7/2011
51224TAGI PHARMA, INC1/14/2005
51248ASTELLAS PHARMA US, INC.1/1/1991
51285TEVA WOMENS HEALTH INC10/12/2016
51293ECI PHARMACEUTICALS LLC7/20/2010
51525WALLACE PHARMACEUTICALS2/12/2005
51645GEMINI PHARMACEUTICALS, INC.4/25/2005
51660OHM PHARMACEUTICALS, INC.1/1/1991
51672TARO PHARMACEUTICALS USA, INC.1/23/2015
51754EXELA PHARMA SCIENCES10/29/2013
51759TEVA PHARMACEUTICALS USA, INC7/1/1995
51801NOMAX, INC.6/15/2011
51862MAYNE PHARMA INC.1/1/1991
51991BRECKENRIDGE PHARMACEUTICAL, INC.6/22/2011
52015MERCK SHARP & DOHME LLC7/20/2010
52054AMEDRA PHARMACEUTICALS, LLC10/7/2011
52244ENDO PHARMACEUTICALS INC.1/18/2011
52246PARAPRO, LLC1/1/1991
52268BRAINTREE LABORATORIES INC.12/15/2010
52276RECORDATI RARE DISEASES8/9/2011
52427ALMATICA PHARMA, LLC.3/9/2011
52536WILSHIRE PHARMACEUTICALS, INC.1/1/1991
52544ACTAVIS PHARMA, INC.8/28/2013
52652AZURITY PHARMACEUTICALS, INC.4/22/2016
52709ALK-Abello A S7/19/2016
52796BONGEO PHARMACEUTICALS, INC.9/20/2018
52817TRUPHARMA, LLC1/16/2013
52856PTC THERAPEUTICS, INC.3/2/2016
52937AMARIN PHARMACEUTICALS IRELAND LTD10/30/2015
53097THE PHARMA NETWORK, LLC6/6/2013
53436VIFOR PHARMA, INC.1/1/1991
53451AZURITY PHARMACEUTICALS INC.1/1/1991
53489SUN PHARMACEUTICAL INDUSTRIES, INC.4/1/1993
53746AMNEAL PHARMACEUTICALS OF NEW YORK LLC7/24/2013
54092TAKEDA PHARMACEUTICALS AMERICA, INC.10/12/2016
54123OREXO US, INC.10/29/2013
54295TRINITY PHARMACEUTICALS LLC1/1/1991
54436ANTARES PHARMA, INC.5/21/2013
54482LEADIANT BIOSCIENCES, INC.11/17/2000
54505LINEAGE THERAPEUTICS INC.7/21/2015
54643SANDOZ MANUFACTURING INC1/1/1991
54766SEBELA PHARMACEUTICALS, INC.7/18/2001
54838LANNETT COMPANY, INC.5/25/2012
54859LLORENS PHARMACEUTICALS INT'L DIVISION5/7/2020
54879STI PHARMA, LLC11/8/2002
54932BIORAMO, LLC.4/29/2020
55111DR. REDDY'S LABORATORIES, INC.9/13/2012
55135GILEAD SCIENCES, INC.4/1/2007
55150Eugia US LLC10/22/2013
55253CIMA LABS, INC.3/4/2016
55292RECORDATI RARE DISEASES, INC.4/12/2013
55466NEOLPHARMA, INC.1/1/1991
55494DUCHESNAY USA, INC.4/1/1994
55513AMGEN INC.5/1/2020
55566FERRING PHARMACEUTICALS, INC.10/6/2014
55670MOORE MEDICAL10/6/2014
55724PFIZER LABORATORIES DIV PFIZER INC.12/7/2015
57237RISING HEALTH, LLC.1/1/1991
57278ROCKWELL MEDICAL, INC.1/1/1991
57664SUN PHARMACEUTICAL INDUSTRIES, INC.10/1/1994
57665LEADIANT BIOSCIENCES, INC.3/30/2020
57782BAUSCH & LOMB INC.1/1/1991
57841REDHILL BIOPHARMA, LTD.1/1/1999
57844TEVA PHARMACEUTICALS USA, INC.4/27/2011
57894JANSSEN BIOTECH, INC11/22/2013
57902JAZZ PHARMACEUTICALS, INC7/9/2014
57962PHARMACYCLICS, LLC.1/1/1997
57970ALLERGAN, INC.10/3/2023
58151VIATRIS SPECIALTY LLC9/8/2023
58284BRAEBURN, INC.1/1/1991
58394WYETH BIOPHARMA DIVISION OF WYETH1/1/1991
58406IMMUNEX CORPORATION12/31/2014
58468GENZYME CORPORATION7/1/1998
58657METHOD PHARMACEUTICALS1/1/1992
58809GM PHARMACEUTICALS, INC.1/1/1996
58914ALLERGAN, INC.7/18/2011
59011PURDUE PHARMA, L.P.8/20/2014
59088PURETEK CORPORATION7/1/1992
59137MEDEXUS PHARMA, INC.10/1/1992
59148OTSUKA AMERICA PHARMACEUTICALS, INC.7/23/2009
59310TEVA RESPIRATORY, LLC10/4/2023
59316RB HEALTH (US) LLC7/18/2023
59338AMAG PHARMACEUTICALS, INC.4/24/2018
59353VIFOR (INTERNATIONAL) INC.9/30/2014
59365COOPER SURGICAL INC.6/22/2007
59385BIODELIVERY SCIENCES INTERNATIONAL, INC9/23/2015
59417TAKEDA PHARMACEUTICALS AMERICA, INC.10/1/1992
59467HIKMA SPECIALTY USA INC.10/1/1997
59528NEPHRO-TECH, INC.9/26/2014
59572CELGENE CORPORATION10/1/1996
59617STALLERGENES, INC.4/1/1993
59627BIOGEN IDEC MA, INC.8/16/2016
59630SHIONOGI INC.7/1/1993
59651AUROBINDO PHARMA USA, INC.7/1/1998
59676JANSSEN PRODUCTS, LP3/14/2006
59730ADMA BIOLOGICS, INC.7/1/1993
59746JUBILANT CADISTA PHARMACEUTICALS, INC.8/7/2012
59762GREENSTONE LLC4/5/2018
59767DIGESTIVE CARE, INC.12/19/2014
59922AKEBIA THERAPEUTICS, INC.1/28/2021
59923AREVA PHARMACEUTICALS10/1/1993
60219AMNEAL PHARMACEUTICALS1/1/1994
60432MORTON GROVE PHARMACEUTICALS, INC4/1/1995
60505APOTEX CORP.8/22/2014
60574MEDIMMUNE, INC.4/8/2015
60631AZURITY PHARMACEUTICALS INC.7/1/1997
60687AMERICAN HEALTH PACKAGING10/1/1994
60758PACIFIC PHARMA, INC.7/3/2014
60793PFIZER LABORATORIES DIV PFIZER INC.10/5/2015
60842KALEO, INC4/1/1994
60846AMNEAL PHARMACEUTICALS LLC2/17/2004
60923SAREPTA THERAPEUTICS INC.12/20/2021
60951PAR PHARMACEUTICAL5/20/2014
60977BAXTER HEALTHCARE CORPORATION1/1/1995
61168KYTHERA BIOPHARMACEUTICALS INC.4/30/2008
61269H2-PHARMA, LLC1/1/1995
61314SANDOZ INC.2/15/2019
61442CARLSBAD TECHNOLOGY, INC.10/28/2004
61570PFIZER LABORATORIES DIV PFIZER INC.4/1/1996
61621ACELRX PHARMACEUTICALS, INC.3/28/2008
61703HOSPIRA, INC.3/15/2004
61755REGENERON PHARMACEUTICALS, INC.4/1/1996
61825Galt Pharmaceuticals LLC8/19/2019
61874ALLERGAN, INC.12/15/2011
61953GRIFOLS USA, LLC4/1/1997
61958GILEAD SCIENCES, INC.4/30/2014
61990APOLLO PHARMACEUTICALS INC.7/3/2014
62011STRATEGIC SOURCING SERVICES LLC4/1/1996
62037ACTAVIS PHARMA, INC.4/2/2015
62064THERATECHNOLOGIES INC.10/6/2015
62135CHARTWELL RX LLC6/25/2014
62175LANNETT COMPANY, INC.4/2/2015
62225OMEROS CORPORATION1/22/2015
62332ALEMBIC PHARMACEUTICALS INC.4/8/2006
62484NOVA LABORATORIES, LTD4/26/2006
62542NEOS THERAPEUTICS, LP1/1/1997
62559ANI PHARMACEUTICALS, INC.6/2/2014
62584AMERICAN HEALTH PACKAGING4/11/2002
62756SUN PHARMACEUTICAL INDUSTRIES INC.1/1/1997
62856EISAI INC.2/21/2003
62935TOLMAR, INC.5/26/2016
63004MALLINCKRODT ARD LLC.10/1/1997
63010AGOURON4/1/1998
63020TAKEDA PHARMACEUTICALS AMERICA INC.10/1/1997
63090ACADIA PHARMACEUTICALS, INC.4/1/1999
63304SUN PHARMACEUTICALS INDUSTRIES, INC.4/1/1999
63323FRESENIUS KABI USA, LLC4/1/1998
63395DAIICHI SANKYO, INC.1/30/2017
63402Sumitomo Pharma America, Inc.1/1/1998
63459CEPHALON, INC.5/24/2013
63481ENDO PHARMACEUTICALS, INC.1/1/1998
63646TOLMAR, INC.1/1/1999
63653BRISTOL-MYERS SQUIBB/SANOFI PARTNERSHIP6/12/2009
63704PHARMACIST PHARMACEUTICAL LLC4/1/1998
63739MCKESSON CORPORATION DBA SKY PACKAGING10/1/1999
63801SMG PHARMACEUTICALS, LLC7/27/2023
63824RB HEALTH (US) LLC3/24/2000
63833CSL BEHRING GMBH5/9/2013
64011AMAG PHARMACEUTICALS, INC.5/14/2008
64193Takeda Pharmaceuticals America, Inc.1/1/1999
64208BIO PRODUCTS LABORATORY4/29/2013
64370PIERRE FABRE PHARMACEUTICALS, INC.4/1/1999
64376PAR PHARMACEUTICAL4/1/1999
64380STRIDES PHARMA SCIENCE LIMITED8/9/2007
64406BIOGEN INC.1/26/2005
64455BTA PHARMACEUTICALS, INC.7/25/2006
64597AVANIR PHARMACEUTICALS, INC.10/1/1999
64661JAYMAC PHARMACEUTICALS LLC10/14/2015
64679WOCKHARDT AMERICAS, INC.1/21/2001
64720COREPHARMA, LLC3/23/2012
64764TAKEDA PHARMACEUTICALS AMERICA, INC.10/7/2010
64842TAIHO PHARMACEUTICAL CO., LTD.12/12/2018
64850Elite Laboratories, Inc.10/1/1999
64875DANCO LABORATORIES, LLC7/26/2021
64896AMNEAL PHARMACEUTICALS LLC10/7/2022
64950LEHIGH VALLEY TECHNOLOGIES, INC.12/17/1999
64980RISING PHARMACEUTICALS, INC.5/26/2020
65038Corium, Inc.1/1/2000
65086SANTEN, INC.12/17/1999
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68047LARKEN LABORATORIES, INC.10/30/2008
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71090STRONGBRIDGE U.S. INC.1/31/2019
71093ACI HEALTHCARE USA, INC.2/26/2021
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71127LABORATOIRE FRANCAIS DU FRACTIONNEMENT4/18/2018
71143OPTINOSE US, INC.12/12/2017
71225SLAYBACK PHARMA11/15/2017
71247INNOGENIX, LLC1/11/2021
71258PROGENICS PHARMACEUTICALS, INC.4/28/2023
71269MainPointe Pharmaceuticals LLC5/18/2018
71274PHARMING HEALTHCARE INC.7/31/2018
71287KITE PHARMA, INC.9/5/2018
71288MEITHEAL PHARMACEUTICALS, INC.8/27/2018
71308Trevena, Inc.5/26/2020
71321Brandywine Pharmaceuticals11/3/2020
71332RIGEL PHARMACEUTICALS, INC.1/25/2018
71334AGIOS PHARMACEUTICALS, INC.3/19/2019
71336ALNYLAM PHARMACEUTICALS, INC.8/30/2023
71349VERRICA PHARMACEUTICALS, INC.9/18/2023
71351BROOKFIELD PHARMACEUTICALS, LLC9/18/2023
71369AKARX, INC.8/30/2023
71376IRONSHORE PHARMACEUTICALS, INC.9/8/2023
71390ACACIA PHARMA LTD9/21/2023
71394SPARK THERAPEUTICS, INC.9/30/2019
71403EPI HEALTH, LLC2/4/2019
71558INSMED INCORPORATED4/17/2018
71565Clearside Biomedical Inc.10/22/2018
71571ALCON LABORATORIES, INC.3/16/2020
71626MEDSTONE PHARMA LLC10/6/2023
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71671AGILE THERAPEUTICS, INC.10/25/2018
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71715PARATEK PHARMACEUTICALS, INC.6/22/2021
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71770MEDUNIK USA1/10/2019
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71776EYEVANCE PHARMACEUTICALS LLC9/6/2018
71779VERASTEM, INC.8/9/2021
71837PARTNER THERAPEUTICS, INC.7/24/2018
71839BE PHARMACEUTICALS INC.2/4/2019
71858IBSA PHARMA, INC.9/23/2019
71863ETON PHARMACEUTICALS, INC.11/6/2019
71879EYEPOINT PHARMACEUTICALS US, INC.3/19/2020
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71894NOVARTIS GENE THERAPIES, INC.10/15/2019
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72060INTRA-CELLULAR THERAPIES, INC.10/3/2018
72064BLUEPRINT MEDICINES CORPORATION7/18/2019
72065XERIS PHARMACEUTICALS, INC.1/18/2022
72078Mylan Institutional LLC3/5/2020
72089Evoke Pharma Inc.9/12/2019
72124CIRCASSIA PHARMACEUTICALS INC.6/20/2019
72126AKCEA THERAPEUTICS, INC.1/17/2020
72152SAGE THERAPEUTICS3/31/2020
72187STEMLINE THERAPEUTICS, INC.4/12/2022
72205NOVADOZ PHARMACEUTICALS, LLC9/13/2019
72237KARYOPHARM THERAPEUTICS1/23/2019
72241Modavar Pharmaceuticals LLC8/19/2022
72245FORTE BIO-PHARMA LLC10/22/2018
72252NEURELIS, INC.4/11/2019
72266FOSUN PHARMA USA3/2/2021
72305PROVELL PHARMACEUTICALS, LLC.10/8/2019
72319i3 Pharmaceuticals, LLC7/18/2023
72336LiFsa Drugs LLC12/5/2019
72426ESPERION THERAPEUTICS, INC.12/11/2019
72482CTI BioPharma Corp6/12/2019
72485ARMAS PHARMACEUTICALS INC.1/30/2020
72493UROGEN PHARMA, INC.2/2/2020
72495MILLICENT U.S., INC.3/24/2020
72511AMGEN USA INC.1/2/2019
72512AVERITAS PHARMA, INC.12/6/2019
72516ORYZA PHARMACEUTICALS, INC.9/18/2023
72526SHANDONG LUYE PHARMACEUTICAL CO., LTD.7/31/2023
72542Acer Therapeutics7/15/2021
72572CIVICA, INC.7/27/2020
72578VIONA PHARMACEUTICALS INC.10/30/2019
72579BEIGENE USA, INC.5/23/2019
72603NORTHSTAR RX LLC7/6/2021
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72611ALMAJECT, INC.12/27/2019
72618Pfizer Laboratories Div Pfizer Inc4/22/2022
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72694SERVIER PHARMACEUTICALS LLC4/17/2020
72730QED Therapeutics, Inc.1/21/2021
72733SANOFI US CORPORATION2/11/2021
72769BIOCRYST PHARMACEUTICALS, INC.8/4/2021
72786GLOBAL BLOOD THERAPEUTICS, INC.1/6/2020
72819Archis Pharma LLC10/19/2022
72829Rhythm Pharmaceuticals, Inc.2/4/2021
72854RB HEALTH (US) LLC1/13/2021
72888Advagen Pharma Ltd4/15/2021
72893ACROTECH BIOPHARMA LLC9/12/2022
72903ImmunoGen, Inc.2/25/2021
72912ADLON THERAPEUTICS L.P.3/16/2021
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72974Sumitomo Pharma America, Inc.8/20/2020
72989Acertis Pharmaceuticals9/3/2020
73042Y-mAbs Therapeutics, Inc7/27/2018
73059Shield Therapeutics3/28/2022
73063Amylyx Pharmaceuticals4/7/2021
73070NOVO NORDISK PHARMA, INC.5/23/2022
73077Fennec Pharmaceuticals, Inc.10/25/2021
73079Eiger Biopharmaceuticals Inc.10/22/2021
73090EUSA Pharma (US) LLC10/15/2020
73116Secura Bio, Inc.3/9/2021
73129Origin Biosciences, Inc.9/14/2020
73150TG THERAPEUTICS, INC.12/28/2021
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73154Ardelyx, Inc.7/5/2023
73179Reata Pharmaceuticals, Inc.8/13/2020
73207DECIPHERA PHARMACEUTICALS, LLC4/16/2021
73289Aucta Pharmaceuticals, Inc.12/30/2021
73292NS PHARMA, INC.4/9/2021
73302HRA PHARMA AMERICA, INC.7/21/2021
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73475Argenx US, Inc.7/18/2022
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75987HORIZON THERAPEUTICS USA, INC.10/7/2021
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76075ONYX PHARMACEUTICAL5/11/2021
76125KEDRION BIOPHARMA, INC4/21/2021
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76204RITEDOSE PHARMACEUTICALS, LLC2/25/2022
76282EXELAN PHARMACEUTICALS, INC5/3/2022
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76336HRA PHARMA AMERICA INC.4/27/2021
76346CORCEPT THERAPEUTICS INCORPORATED4/22/2021
76385BAYSHORE PHARMACEUTICALS LLC9/2/2022
76388ASPEN GLOBAL INCORPORATED2/23/2022
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81665Omnivium Pharmaceutical12/7/2022
81672Dermavant Sciences Inc.2/23/2022
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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 01/26/2024. 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: 02/6/2024