Medicaid Drug Rebate Program
Labeler Reference for NDCs included under the Medicaid Drug Rebate Program
Labeler Code | Labeler Name | Effective Date | Notes |
---|---|---|---|
00002 | ELI LILLY AND COMPANY | 1991-01-01 00:00:00 | |
00003 | E.R. SQUIBB & SONS, LLC. | 1991-01-01 00:00:00 | |
00004 | GENENTECH, INC. | 1991-01-01 00:00:00 | |
00006 | MERCK SHARP & DOHME LLC | 1991-01-01 00:00:00 | |
00007 | GLAXOSMITHKLINE LLC | 1991-01-01 00:00:00 | |
00008 | WYETH PHARMACEUTICALS LLC, | 1991-01-01 00:00:00 | |
00009 | PHARMACIA AND UPJOHN COMPANY LLC | 1991-01-01 00:00:00 | |
00013 | PFIZER LABORATORIES DIV PFIZER INC | 1991-01-01 00:00:00 | |
00023 | ALLERGAN INC | 1991-01-01 00:00:00 | |
00024 | SANOFI-AVENTIS, US LLC | 1991-01-01 00:00:00 | |
00025 | PFIZER LABORATORIES DIV PFIZER INC | 1991-01-01 00:00:00 | |
00026 | BAYER HEALTHCARE LLC | 1991-01-01 00:00:00 | |
00032 | ABBVIE INC. | 1991-01-01 00:00:00 | |
00037 | MEDA PHARMACEUTICALS, INC. | 1991-01-01 00:00:00 | |
00039 | SANOFI-AVENTIS, US LLC | 1991-01-01 00:00:00 | |
00046 | WYETH PHARMACEUTICALS INC. | 1991-01-01 00:00:00 | |
00049 | ROERIG | 1991-01-01 00:00:00 | |
00051 | ABBVIE INC | 1997-10-01 00:00:00 | |
00052 | MERCK SHARP & DOHME LLC | 1991-01-01 00:00:00 | |
00053 | CSL BEHRING L.L.C. | 1991-01-01 00:00:00 | |
00054 | HIKMA PHARMACEUTICALS USA INC. | 1991-01-01 00:00:00 | |
00056 | BRISTOL-MYERS SQUIBB PHARMA CO. | 1991-01-01 00:00:00 | |
00065 | ALCON LABORATORIES, INC. | 1991-01-01 00:00:00 | |
00068 | SANOFI-AVENTIS U.S. LLC | 1991-01-01 00:00:00 | |
00069 | PFIZER LABORATORIES DIV PFIZER INC | 1991-01-01 00:00:00 | |
00071 | PARKE-DAVIS DIV OF PFIZER | 1991-01-01 00:00:00 | |
00074 | ABBVIE INC | 1991-01-01 00:00:00 | |
00075 | SANOFI-AVENTIS U.S. LLC | 1991-01-01 00:00:00 | |
00078 | NOVARTIS PHARMACEUTICALS CORPORATION | 1991-01-01 00:00:00 | |
00085 | MERCK SHARP & DOHME LLC | 1991-01-01 00:00:00 | |
00088 | SANOFI-AVENTIS U.S.LLC | 1991-01-01 00:00:00 | |
00093 | TEVA PHARMACEUTICALS USA, INC. | 1991-01-01 00:00:00 | |
00095 | BAUSCH HEALTH US, LLC | 1991-10-01 00:00:00 | |
00096 | PERSON & COVEY, INC. | 1999-04-01 00:00:00 | |
00113 | L. PERRIGO COMPANY | 2003-04-30 00:00:00 | |
00115 | AMNEAL PHARMACEUTICALS OF NEW YORK LLC | 1991-01-01 00:00:00 | |
00116 | XTTRIUM LABORATORIES, INC. | 2001-08-17 00:00:00 | |
00121 | PAI | 1991-01-01 00:00:00 | |
00131 | UCB, INC. | 1991-01-01 00:00:00 | |
00132 | C B FLEET COMPANY INC | 1991-01-01 00:00:00 | |
00143 | HIKMA PHARMACEUTICALS USA INC. | 1991-01-01 00:00:00 | |
00168 | E FOUGERA AND CO. | 1991-01-01 00:00:00 | |
00169 | NOVO NORDISK, INC. | 1991-01-01 00:00:00 | |
00172 | TEVA PHARMACEUTICALS USA, INC | 1991-01-01 00:00:00 | |
00173 | GLAXOSMITHKLINE | 1991-01-01 00:00:00 | |
00178 | MISSION PHARMACAL COMPANY | 1991-01-01 00:00:00 | |
00185 | EON LABS, INC. | 1991-01-01 00:00:00 | |
00186 | ASTRAZENECA PHARMACEUTICALS LP | 1991-01-01 00:00:00 | |
00187 | BAUSCH HEALTH US, LLC. | 1991-01-01 00:00:00 | |
00206 | WYETH PHARMACEUTICALS LLC, | 1991-01-01 00:00:00 | |
00224 | KONSYL PHARMACEUTICALS, INC. | 1992-01-01 00:00:00 | |
00228 | ACTAVIS PHARMA, INC. | 1991-01-01 00:00:00 | |
00245 | UPSHER-SMITH LABORATORIES, INC. | 1991-01-01 00:00:00 | |
00254 | PAR PHARMACEUTICAL INC. | 2018-09-28 00:00:00 | |
00259 | MERZ PHARMACEUTICALS | 1991-01-01 00:00:00 | |
00264 | B. BRAUN MEDICAL INC. | 1991-01-01 00:00:00 | |
00281 | SAVAGE LABORATORIES | 1991-01-01 00:00:00 | |
00310 | ASTRAZENECA PHARMACEUTICALS LP | 1991-01-01 00:00:00 | |
00338 | BAXTER HEALTHCARE CORPORATION | 1991-01-01 00:00:00 | |
00378 | MYLAN PHARMACEUTICALS, INC. | 1991-01-01 00:00:00 | |
00406 | SPEC GX, LLC | 1991-10-01 00:00:00 | |
00407 | GE HEALTHCARE, INC. | 2011-07-05 00:00:00 | |
00409 | HOSPIRA, INC. | 2004-10-28 00:00:00 | |
00430 | ALLERGAN, INC. | 1998-01-01 00:00:00 | |
00456 | ALLERGAN, INC. | 1991-01-01 00:00:00 | |
00469 | ASTELLAS PHARMA US, INC. | 1991-01-01 00:00:00 | |
00472 | ACTAVIS PHARMA, INC. | 1991-01-01 00:00:00 | |
00480 | Teva Pharmaceuticals, Inc. | 2022-03-01 00:00:00 | |
00485 | EDWARDS PHARMACEUTICALS, INC. | 1991-01-01 00:00:00 | |
00486 | BEACH PHARMACEUTICALS | 1991-01-01 00:00:00 | |
00487 | NEPHRON PHARMACEUTICALS CORPORATION | 1992-04-01 00:00:00 | |
00517 | AMERICAN REGENT, INC. | 1991-10-01 00:00:00 | |
00527 | LANNETT COMPANY, INC. | 1994-07-01 00:00:00 | |
00536 | RUGBY LABORATORIES | 1991-01-01 00:00:00 | |
00548 | AMPHASTAR PHARMACEUTICALS, INC. | 2012-10-22 00:00:00 | |
00555 | TEVA PHARMACEUTICALS USA, INC | 1991-01-01 00:00:00 | |
00562 | KEDRION MELVILLE, INC. | 2013-01-18 00:00:00 | |
00574 | PADAGIS US LLC | 1991-01-01 00:00:00 | |
00575 | TEVA PHARMACEUTICALS USA, INC | 1991-10-01 00:00:00 | |
00591 | ACTAVIS PHARMA, INC. | 2001-03-29 00:00:00 | |
00597 | BOEHRINGER INGELHEIM PHARMACEUTICALS | 1991-01-01 00:00:00 | |
00603 | PAR PHARMACEUTICAL | 1991-01-01 00:00:00 | |
00641 | HIKMA PHARMACEUTICALS USA INC. | 1991-01-01 00:00:00 | |
00642 | EXELTIS USA, INC. | 1991-01-01 00:00:00 | |
00682 | MARNEL PHARMACEUTICALS, LLC | 1991-01-01 00:00:00 | |
00703 | TEVA PARENTERAL MEDICINES INC | 1992-07-01 00:00:00 | |
00713 | COSETTE PHARMACEUTICALS, INC. | 1991-07-01 00:00:00 | |
00777 | DISTA PRODUCTS COMPANY | 1991-01-01 00:00:00 | |
00781 | SANDOZ | 1991-01-01 00:00:00 | |
00813 | PHARMICS INC. | 1991-01-01 00:00:00 | |
00832 | UPSHER-SMITH LABORATORIES, LLC. | 1991-01-01 00:00:00 | |
00884 | PEDINOL PHARMACAL INC | 1991-01-01 00:00:00 | |
00904 | MAJOR PHARMACEUTICALS | 1991-01-01 00:00:00 | |
00941 | BAXTER HEALTHCARE CORPORATION | 2010-04-01 00:00:00 | |
00944 | BAXALTA US INC. | 1991-01-01 00:00:00 | |
00955 | WINTHROP U.S. | 1996-01-01 00:00:00 | |
00990 | ICU MEDICAL INC. | 2018-07-12 00:00:00 | |
00998 | ALCON LABORATORIES, INC. | 1991-01-01 00:00:00 | |
10019 | BAXTER HEALTHCARE CORPORATION | 2001-06-28 00:00:00 | |
10094 | AQUESTIVE THERAPEUTICS | 2018-12-05 00:00:00 | |
10122 | CHIESI USA, INC. | 2005-04-26 00:00:00 | |
10144 | ACORDA THERAPEUTICS, INC. | 2005-05-27 00:00:00 | |
10147 | PATRIOT PHARMACEUTICALS, LLC. | 2005-01-13 00:00:00 | |
10148 | COTHERIX, INC. | 2018-09-06 00:00:00 | |
10337 | PHARMADERM (DIVISION OF FOUGERA PHARMA) | 2002-04-16 00:00:00 | |
10370 | PAR PHARMACEUTICALS, INC. | 2007-05-14 00:00:00 | |
10454 | SOLSTICE NEUROSCIENCES, LLC. | 2005-10-18 00:00:00 | |
10542 | HILLESTAD PHARMACEUTICALS USA | 1994-04-01 00:00:00 | |
10572 | AFFORDABLE PHARMACEUTICALS, LLC | 2004-11-01 00:00:00 | |
10599 | INTERSECT ENT, INC. | 2018-02-12 00:00:00 | |
10631 | SUN PHARMACEUTICALS INDUSTRIES, INC. | 2005-07-20 00:00:00 | |
10702 | KVK-TECH, INC. | 2006-10-10 00:00:00 | |
10922 | INTENDIS, INC. | 2005-08-01 00:00:00 | |
11527 | SHEFFIELD PHARMACEUTICALS | 2020-04-28 00:00:00 | |
11534 | SUNRISE PHARMACEUTICAL, INC. | 2015-10-12 00:00:00 | |
11980 | ALLERGAN INC | 1991-01-01 00:00:00 | |
11994 | LANTHEUS MEDICAL IMAGING, INC. | 2010-10-06 00:00:00 | |
12496 | INDIVOR INC. | 1994-01-01 00:00:00 | |
12830 | R.A. MCNEIL COMPANY | 1991-01-01 00:00:00 | |
13107 | AUROBINDO PHARMA USA, INC. | 2005-06-02 00:00:00 | |
13517 | E5 PHARMA, LLC | 2017-01-30 00:00:00 | |
13533 | GRIFOLS USA, LLC | 2005-07-21 00:00:00 | |
13548 | BAUSCH HEALTH US, LLC | 2006-04-01 00:00:00 | |
13668 | TORRENT PHARMACEUTICALS LIMITED | 2007-07-02 00:00:00 | |
13811 | TRIGEN LABORATORIES, LLC | 2006-01-09 00:00:00 | |
13925 | SETON PHARMACEUTICALS, LLC | 2008-11-18 00:00:00 | |
14539 | HERITAGE PHARMACEUTICALS, INC. | 2019-07-29 00:00:00 | |
14789 | NEXUS PHARMACEUTICALS, INC. | 2018-01-09 00:00:00 | |
15054 | IPSEN BIOPHARMACEUTICALS | 2006-01-26 00:00:00 | |
15370 | CARWIN PHARMACEUTICAL ASSOCIATES, LLC. | 2006-06-16 00:00:00 | |
15584 | GILEAD SCIENCES, LLC. | 2006-07-01 00:00:00 | |
16252 | ACTAVIS PHARMA, INC. | 2006-06-01 00:00:00 | |
16571 | RISING PHARMACEUTICALS, INC | 2006-01-17 00:00:00 | |
16714 | NORTHSTAR RX LLC | 2008-01-15 00:00:00 | |
16729 | ACCORD HEALTHCARE INC. | 2008-03-10 00:00:00 | |
16781 | BAUSCH HEALTH US, LLC | 2018-09-12 00:00:00 | |
17433 | ENEMEEZ, INC. DBA SUMMIT PHARMACEUTICAL | 2006-12-13 00:00:00 | |
17478 | Akorn Operating Company LLC | 1991-01-01 00:00:00 | |
17772 | SUPERNUS PHARMACEUTICALS, INC. | 2013-01-24 00:00:00 | |
18657 | HALOZYME THERAPEUTICS, INC. | 2012-02-03 00:00:00 | |
18860 | JAZZ PHARMACEUTICALS, INC | 2006-10-10 00:00:00 | |
21724 | INDEPENDENCE PHARMACEUTICALS, LLC | 2014-05-28 00:00:00 | |
21922 | ENCUBE ETHICALS PVT. LTD. | 2019-09-05 00:00:00 | |
23155 | HERITAGE PHARMACEUTICALS, INC. | 2006-11-09 00:00:00 | |
23359 | CENTURION LABS, LLC | 2010-01-06 00:00:00 | |
23594 | AYTU THERAPEUTICS, LLC | 2014-04-24 00:00:00 | |
23635 | SPEC GX, LLC. | 2007-02-05 00:00:00 | |
24201 | LEUCADIA PHARMACEUTICALS | 2018-01-30 00:00:00 | |
24208 | BAUSCH & LOMB INC. | 1991-01-01 00:00:00 | |
24338 | AZURITY PHARMACEUTICALS INC. | 2007-08-01 00:00:00 | |
24385 | AMERISOURCE BERGEN | 1991-10-01 00:00:00 | |
24478 | NEXTWAVE PHARMACEUTICALS, INC. | 2007-06-07 00:00:00 | |
24492 | PARI RESPIRATORY EQUIPMENT, INC. | 2015-01-22 00:00:00 | |
24510 | COLLEGIUM PHARMACEUTICAL, INC. | 2016-05-26 00:00:00 | |
24658 | PURACAP LAB. DBA BLU PHARMACEUTICALS | 2011-12-11 00:00:00 | |
24689 | APNAR PHARMA LP | 2020-12-28 00:00:00 | |
24979 | TWI PHARMACEUTICALS, INC. | 2015-01-29 00:00:00 | |
25010 | BAUSCH HEALTH US, LLC | 2007-10-22 00:00:00 | |
25021 | SAGENT PHARMACEUTICALS, INC. | 2008-08-06 00:00:00 | |
25208 | MEDICURE INTERNATIONAL, INC. | 2008-05-15 00:00:00 | |
25682 | ALEXION PHARMACEUTICALS | 2007-04-11 00:00:00 | |
27241 | AJANTA PHARMA LIMITED | 2014-04-29 00:00:00 | |
27437 | LUPIN PHARMACEUTICALS, INC. | 2007-03-31 00:00:00 | |
27505 | MDD US OPERATIONS, LLC. | 2012-08-01 00:00:00 | |
27808 | TRIS PHARMA, INC. | 2010-11-30 00:00:00 | |
28595 | ALLEGIS PHARMACEUTICALS LLC | 2007-07-05 00:00:00 | |
29033 | NOSTRUM LABORATORIES | 2007-04-24 00:00:00 | |
29300 | UNICHEM PHARMACEUTICALS (USA), INC. | 2008-08-25 00:00:00 | |
29978 | CAPITAL PHARMACEUTICAL, LLC | 2009-03-25 00:00:00 | |
30237 | DENDREON PHARMACEUTICALS LLC | 2010-07-30 00:00:00 | |
30698 | VALIDUS PHARMACEUTICALS, LLC. | 2007-07-05 00:00:00 | |
31722 | CAMBER PHARMACEUTICALS, INC. | 2007-10-03 00:00:00 | |
33342 | MACLEODS PHARMACEUTICALS LIMITED | 2012-07-12 00:00:00 | |
35573 | BUREL PHARMACEUTICALS | 2011-03-21 00:00:00 | |
36000 | BAXTER HEALTHCARE CORPORATION | 2018-06-01 00:00:00 | |
37205 | CARDINAL HEALTH | 1994-10-01 00:00:00 | |
39328 | PATRIN PHARMA, INC. | 2016-06-27 00:00:00 | |
39822 | XGEN PHARMACEUTICALS DJB, INC. | 2000-04-13 00:00:00 | |
41616 | SUN PHARMA GLOBAL, INC. | 2008-10-27 00:00:00 | |
42023 | PAR PHARMACEUTICAL, INC. | 2008-01-17 00:00:00 | |
42192 | ACELLA PHARMACEUTICALS, LLC | 2018-09-28 00:00:00 | |
42195 | XSPIRE PHARMA LLC | 2012-09-19 00:00:00 | |
42227 | VIROPHARMA BIOLOGICS, INC. | 2009-01-01 00:00:00 | |
42292 | MYLAN INSTITUTIONAL INC. | 2015-07-24 00:00:00 | |
42358 | SENTYNL THERAPEUTICS, INC. | 2015-06-17 00:00:00 | |
42367 | EAGLE PHARMACEUTICALS, INC. | 2014-07-28 00:00:00 | |
42385 | LAURUS LABS PRIVATE LIMITED | 2018-04-27 00:00:00 | |
42388 | EXELIXIS, INC. | 2013-02-12 00:00:00 | |
42457 | EMMAUS MEDICAL, INC. | 2008-08-12 00:00:00 | |
42494 | CAMERON PHARMACEUTICALS, LLC. | 2016-09-07 00:00:00 | |
42543 | VENSUN PHARMACEUTICALS, INC. | 2014-08-13 00:00:00 | |
42571 | MICRO LABS LIMITED | 2013-04-29 00:00:00 | |
42658 | HISUN PHARMACEUTICALS USA, INC. | 2019-08-05 00:00:00 | |
42667 | ACERUS PHARMACEUTICALS CORPORATION | 2020-08-31 00:00:00 | |
42702 | PARAGON BIOTECK, INC. | 2013-07-16 00:00:00 | |
42747 | KYOWA KIRIN, INC, | 2008-12-24 00:00:00 | |
42794 | SIGMAPHARM LABORATORIES, LLC | 2012-01-27 00:00:00 | |
42799 | EDENBRIDGE PHARMACEUTICALS LLC | 2009-12-16 00:00:00 | |
42806 | EPIC PHARMA LLC | 2010-01-26 00:00:00 | |
42847 | CURRAX PHARMACEUTICALS, LLC. | 2010-10-14 00:00:00 | |
42858 | RHODES PHARMACEUTICALS L.P. | 2009-12-02 00:00:00 | |
43066 | BAXTER HEALTHCARE CORPORATION | 2011-08-12 00:00:00 | |
43068 | VANDA PHARMACEUTICALS, INC. | 2009-07-30 00:00:00 | |
43199 | COUNTY LINE PHARMACEUTICALS, LLC | 2009-07-27 00:00:00 | |
43376 | ZOGENIX, INC. | 2011-01-31 00:00:00 | |
43386 | LUPIN PHARMACEUTICALS, INC. | 2009-06-09 00:00:00 | |
43393 | GENBIOPRO, INC. | 2013-01-22 00:00:00 | |
43485 | APRECIA PHARMACEUTICALS, LLC | 2016-04-25 00:00:00 | |
43538 | MEDIMETRIKS PHARMACEUTICALS, INC. | 2008-12-30 00:00:00 | |
43547 | SOLCO HEALTHCARE USA, LLC | 2009-05-12 00:00:00 | |
43598 | DR. REDDY'S LABORATORIES, INC. | 2011-04-18 00:00:00 | |
43975 | ANI PHARMACEUTICALS, INC. | 2014-02-11 00:00:00 | |
44087 | EMD SERONO, INC. | 1991-10-01 00:00:00 | |
44183 | CURRAX PHARMACEUTICALS, LLC. | 2009-05-30 00:00:00 | |
44206 | CSL BEHRING AG | 2001-11-20 00:00:00 | |
44523 | BIOCOMP PHARMA, INC. | 2009-01-20 00:00:00 | |
44567 | WG CRITICAL CARE, LLC | 2009-04-28 00:00:00 | |
45043 | MANCHESTER PHARMACEUTICALS CORPORATION | 2010-01-14 00:00:00 | |
45629 | Aveo Pharmaceuticals, Inc | 2021-04-13 00:00:00 | |
45802 | PADAGIS ISRAEL PHARMACEUTICALS LTD. | 1991-01-01 00:00:00 | |
45963 | ACTAVIS PHARMA, INC. | 2009-10-15 00:00:00 | |
46017 | MYLAN CONSUMER HEALTHCARE, INC. | 2018-11-09 00:00:00 | |
46122 | AMERISOURCE BERGEN | 2010-07-05 00:00:00 | |
46287 | CMP PHARMA, INC. | 1993-10-01 00:00:00 | |
46672 | MIKART INC. | 1991-01-01 00:00:00 | |
46783 | MERZ NORTH AMERICA, INC. | 2013-03-28 00:00:00 | |
47335 | SUN PHARMACEUTICALS INDUSTRIES, INC. | 2009-12-30 00:00:00 | |
47426 | HERON THERAPEUTICS, INC. | 2016-09-14 00:00:00 | |
47781 | ALVOGEN INC. | 2010-01-29 00:00:00 | |
47783 | DYAX CORP. | 2010-01-28 00:00:00 | |
47918 | MANNKIND CORPORATION | 2016-10-20 00:00:00 | |
48102 | FERA PHARMACEUTICALS, LLC | 2009-12-23 00:00:00 | |
48818 | Acrotech Biopharma LLC | 2009-10-28 00:00:00 | |
49230 | FRESENIUS MEDICAL CARE NORTH AMERICA | 2007-01-22 00:00:00 | |
49348 | STRATEGIC SOURCING SERVICES LLC | 1991-01-01 00:00:00 | |
49401 | GLAXOSMITHKLINE LLC | 2011-03-29 00:00:00 | |
49411 | Akorn Operating Company LLC | 2015-08-27 00:00:00 | |
49483 | TIME CAP LABORATORIES, INC. | 1992-10-01 00:00:00 | |
49502 | MYLAN SPECIALTY L.P. | 1991-01-01 00:00:00 | |
49702 | VIIV HEALTHCARE COMPANY | 2010-10-19 00:00:00 | |
49708 | SUN PHARMACEUTICALS INDUSTRIES, INC. | 2010-01-04 00:00:00 | |
49730 | HERCON PHARMACEUTICALS, LLC | 2014-10-06 00:00:00 | |
49884 | PAR PHARMACEUTICAL | 1991-01-01 00:00:00 | |
49909 | EDGEMONT PHARMACEUTICALS, LLC | 2012-01-12 00:00:00 | |
50102 | AFAXYS PHARMA, INC. | 2013-01-17 00:00:00 | |
50111 | TEVA PHARMACEUTICALS USA, INC | 1991-01-01 00:00:00 | |
50222 | LEO PHARMA INC. | 2010-02-23 00:00:00 | |
50228 | SCIEGEN PHARMACEUTICALS, INC. | 2018-10-11 00:00:00 | |
50242 | GENENTECH, INC. | 1991-01-01 00:00:00 | |
50261 | THERAPEUTICSMD | 2019-10-23 00:00:00 | |
50268 | AVPAK | 2017-09-25 00:00:00 | |
50383 | Akorn Operating Company LLC | 1991-01-01 00:00:00 | |
50419 | BAYER HEALTHCARE PHARMACEUTICALS, INC | 1991-01-01 00:00:00 | |
50458 | JANSSEN PHARMACEUTICALS, INC | 1991-01-01 00:00:00 | |
50474 | UCB, INC. | 1991-01-01 00:00:00 | |
50742 | INGENUS PHARMACEUTICALS, LLC | 2011-03-25 00:00:00 | |
50844 | LNK INTERNATIONAL, INC. | 1996-10-01 00:00:00 | |
50881 | INCYTE CORPORATION | 2011-12-08 00:00:00 | |
50967 | WOMENS CHOICE PHARMACEUTICALS | 2011-05-13 00:00:00 | |
50991 | POLY PHARMACEUTICALS, INC. | 1991-01-01 00:00:00 | |
51079 | MYLAN INSTITUTIONAL, INC | 1991-01-01 00:00:00 | |
51144 | SEAGEN INC. | 2011-09-26 00:00:00 | |
51167 | VERTEX PHARMACEUTICALS, INC. | 2011-03-14 00:00:00 | |
51224 | TAGI PHARMA, INC | 2011-04-07 00:00:00 | |
51248 | ASTELLAS PHARMA US, INC. | 2005-01-14 00:00:00 | |
51267 | NALPROPION PHARMACEUTICALS | 2017-01-19 00:00:00 | |
51285 | TEVA WOMENS HEALTH INC | 1991-01-01 00:00:00 | |
51293 | ECI PHARMACEUTICALS LLC | 2016-10-12 00:00:00 | |
51525 | WALLACE PHARMACEUTICALS | 2010-07-20 00:00:00 | |
51645 | GEMINI PHARMACEUTICALS, INC. | 2005-02-12 00:00:00 | |
51660 | OHM PHARMACEUTICALS, INC. | 2005-04-25 00:00:00 | |
51672 | TARO PHARMACEUTICALS USA, INC. | 1991-01-01 00:00:00 | |
51754 | EXELA PHARMA SCIENCES | 2015-01-23 00:00:00 | |
51759 | TEVA PHARMACEUTICALS USA, INC | 2013-10-29 00:00:00 | |
51801 | NOMAX, INC. | 1995-07-01 00:00:00 | |
51862 | MAYNE PHARMA INC. | 2011-06-15 00:00:00 | |
51991 | BRECKENRIDGE PHARMACEUTICAL, INC. | 1991-01-01 00:00:00 | |
52015 | MERCK SHARP & DOHME LLC | 2011-06-22 00:00:00 | |
52054 | AMEDRA PHARMACEUTICALS, LLC | 2010-07-20 00:00:00 | |
52244 | ENDO PHARMACEUTICALS INC. | 2011-10-07 00:00:00 | |
52246 | PARAPRO, LLC | 2011-01-18 00:00:00 | |
52268 | BRAINTREE LABORATORIES INC. | 1991-01-01 00:00:00 | |
52276 | RECORDATI RARE DISEASES | 2010-12-15 00:00:00 | |
52427 | ALMATICA PHARMA, LLC. | 2011-08-09 00:00:00 | |
52536 | WILSHIRE PHARMACEUTICALS, INC. | 2011-03-09 00:00:00 | |
52544 | ACTAVIS PHARMA, INC. | 1991-01-01 00:00:00 | |
52652 | AZURITY PHARMACEUTICALS, INC. | 2013-08-28 00:00:00 | |
52709 | ALK-ABELLO A S | 2016-04-22 00:00:00 | |
52796 | BONGEO PHARMACEUTICALS, INC. | 2016-07-19 00:00:00 | |
52817 | TRUPHARMA, LLC | 2018-09-20 00:00:00 | |
52856 | PTC THERAPEUTICS, INC. | 2013-01-16 00:00:00 | |
52937 | AMARIN PHARMACEUTICALS IRELAND LTD | 2016-03-02 00:00:00 | |
53097 | THE PHARMA NETWORK, LLC | 2015-10-30 00:00:00 | |
53436 | VIFOR PHARMA, INC. | 2013-06-06 00:00:00 | |
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70709 | CYCLE PHARMACEUTICALS, LTD. | 2019-12-05 00:00:00 | |
70710 | ZYDUS PHARMACEUTICALS (USA) INC. | 2019-10-23 00:00:00 | |
70726 | ITF PHARMA, INC. | 2017-07-31 00:00:00 | |
70727 | AERIE PHARMACEUTICALS, INC. | 2017-10-26 00:00:00 | |
70748 | LUPIN PHARMACEUTICALS INC. | 2017-03-07 00:00:00 | |
70752 | QUAGEN PHARMACUETICALS LLC | 2017-10-31 00:00:00 | |
70756 | LIFESTAR PHARMA LLC | 2017-03-09 00:00:00 | |
70801 | FLEXION THERAPEUTICS, INC. | 2018-04-04 00:00:00 | |
70839 | NODEN PHARMA USA, INC. | 2017-06-08 00:00:00 | |
70842 | MELINTA THERAPEUTICS, INC. | 2017-11-20 00:00:00 | |
70860 | ATHENEX PHARMACEUTICAL DIVISION, LLC | 2018-05-29 00:00:00 | |
70954 | NOVITIUM PHARMA LLC | 2020-12-07 00:00:00 | |
71090 | STRONGBRIDGE U.S. INC. | 2018-01-29 00:00:00 | |
71093 | ACI HEALTHCARE USA, INC. | 2019-01-31 00:00:00 | |
71104 | BIOVERATIV THERAPEUTICS INC. | 2021-02-26 00:00:00 | |
71127 | LABORATOIRE FRANCAIS DU FRACTIONNEMENT | 2018-10-29 00:00:00 | |
71143 | OPTINOSE US, INC. | 2018-04-18 00:00:00 | |
71225 | SLAYBACK PHARMA | 2017-12-12 00:00:00 | |
71247 | INNOGENIX, LLC | 2017-11-15 00:00:00 | |
71258 | PROGENICS PHARMACEUTICALS, INC. | 2021-01-11 00:00:00 | |
71274 | PHARMING HEALTHCARE INC. | 2018-05-18 00:00:00 | |
71287 | KITE PHARMA, INC. | 2018-07-31 00:00:00 | |
71288 | MEITHEAL PHARMACEUTICALS, INC. | 2018-09-05 00:00:00 | |
71308 | Trevena, Inc. | 2018-08-27 00:00:00 | |
71332 | RIGEL PHARMACEUTICALS, INC. | 2020-11-03 00:00:00 | |
71334 | AGIOS PHARMACEUTICALS, INC. | 2018-01-25 00:00:00 | |
71336 | ALNYLAM PHARMACEUTICALS, INC. | 2019-03-19 00:00:00 | |
71369 | AKARX, INC. | 2020-04-07 00:00:00 | |
71376 | IRONSHORE PHARMACEUTICALS, INC. | 2018-10-24 00:00:00 | |
71390 | ACACIA PHARMA LTD | 2022-01-27 00:00:00 | |
71394 | SPARK THERAPEUTICS, INC. | 2019-01-04 00:00:00 | |
71403 | EPI HEALTH, LLC | 2019-09-30 00:00:00 | |
71428 | GLASSHOUSE PHARMACEUTICALS LLC | 2020-10-30 00:00:00 | |
71518 | BAUDAX BIO, INC. | 2020-05-04 00:00:00 | |
71558 | INSMED INCORPORATED | 2019-02-04 00:00:00 | |
71565 | Clearside Biomedical Inc. | 2018-04-17 00:00:00 | |
71571 | ALCON LABORATORIES, INC. | 2018-10-22 00:00:00 | |
71626 | MEDSTONE PHARMA LLC | 2020-03-16 00:00:00 | |
71671 | AGILE THERAPEUTICS, INC. | 2018-12-12 00:00:00 | |
71699 | SK LIFE SCIENCE, INC. | 2018-10-25 00:00:00 | |
71715 | PARATEK PHARMACEUTICALS, INC. | 2021-01-15 00:00:00 | |
64850 | ELITE LABORATORIES, INC. | 2018-12-12 00:00:00 | |
71770 | MEDUNIK USA | 2019-12-03 00:00:00 | |
71773 | TETRAPHASE PHARMACEUTICALS, INC. | 2019-01-10 00:00:00 | |
71776 | EYEVANCE PHARMACEUTICALS LLC | 2020-03-13 00:00:00 | |
71777 | LOXO ONCOLOGY, INC. | 2019-06-11 00:00:00 | |
71779 | VERASTEM, INC. | 2018-09-06 00:00:00 | |
71837 | PARTNER THERAPEUTICS, INC. | 2021-08-09 00:00:00 | |
71839 | BE PHARMACEUTICALS INC. | 2018-07-24 00:00:00 | |
71858 | IBSA PHARMA, INC. | 2019-02-04 00:00:00 | |
71863 | ETON PHARMACEUTICALS, INC. | 2019-09-23 00:00:00 | |
71879 | EYEPOINT PHARMACEUTICALS US, INC. | 2019-11-06 00:00:00 | |
71881 | AIMMUNE THERAPEUTICS, INC. | 2020-03-19 00:00:00 | |
71894 | NOVARTIS GENE THERAPIES, INC. | 2020-02-03 00:00:00 | |
71904 | AMICUS THERAPEUTICS US, INC. | 2019-10-15 00:00:00 | |
71921 | Florida Pharmaceutical Products, LLC | 2021-01-12 00:00:00 | |
71930 | EYWA PHARMA | 2021-01-28 00:00:00 | |
71981 | DOMPE FARMACEUTICI S.P.A. | 2000-08-15 00:00:00 | |
65250 | PACIRA PHARMACEUTICALS, INC. | 2018-10-31 00:00:00 | |
72000 | NABRIVA THERAPEUTICS US, INC. | 2021-10-21 00:00:00 | |
72028 | HARMONY BIOSCIENCES, LLC | 2019-06-26 00:00:00 | |
72060 | INTRA-CELLULAR THERAPIES, INC. | 2019-01-28 00:00:00 | |
72064 | BLUEPRINT MEDICINES CORPORATION | 2018-10-03 00:00:00 | |
72065 | XERIS PHARMACEUTICALS, INC. | 2019-07-18 00:00:00 | |
72078 | Mylan Institutional LLC | 2022-01-18 00:00:00 | |
72089 | Evoke Pharma Inc. | 2020-03-05 00:00:00 | |
72124 | CIRCASSIA PHARMACEUTICALS INC. | 2019-09-12 00:00:00 | |
72126 | AKCEA THERAPEUTICS, INC. | 2019-06-20 00:00:00 | |
72143 | JG PHARMA, INC. | 2022-03-29 00:00:00 | |
72152 | SAGE THERAPEUTICS | 2020-01-17 00:00:00 | |
72187 | STEMLINE THERAPEUTICS, INC. | 2020-03-31 00:00:00 | |
72205 | NOVADOZ PHARMACEUTICALS, LLC | 2022-04-12 00:00:00 | |
72237 | KARYOPHARM THERAPEUTICS | 2019-09-13 00:00:00 | |
72241 | Modavar Pharmaceuticals LLC | 2019-01-23 00:00:00 | |
72252 | NEURELIS, INC. | 2018-10-22 00:00:00 | |
72266 | FOSUN PHARMA USA | 2019-04-11 00:00:00 | |
72305 | PROVELL PHARMACEUTICALS, LLC. | 2021-03-02 00:00:00 | |
72319 | i3 Pharmaceuticals, LLC | 2019-10-08 00:00:00 | |
72356 | VYNE PHARMACEUTICALS INC. | 2019-06-07 00:00:00 | |
72426 | ESPERION THERAPEUTICS, INC. | 2019-12-05 00:00:00 | |
72482 | CTI BioPharma Corp | 2019-12-11 00:00:00 | |
72485 | ARMAS PHARMACEUTICALS INC. | 2019-06-12 00:00:00 | |
72493 | UROGEN PHARMA, INC. | 2020-01-30 00:00:00 | |
72495 | MILLICENT U.S., INC. | 2020-02-02 00:00:00 | |
72511 | AMGEN USA INC. | 2020-03-24 00:00:00 | |
72512 | AVERITAS PHARMA, INC. | 2019-01-02 00:00:00 | |
72516 | ORYZA PHARMACEUTICALS, INC. | 2019-12-06 00:00:00 | |
72572 | CIVICA, INC. | 2021-07-15 00:00:00 | |
72578 | VIONA PHARMACEUTICALS INC. | 2020-07-27 00:00:00 | |
72579 | BEIGENE USA, INC. | 2019-10-30 00:00:00 | |
72603 | NORTHSTAR RX LLC | 2019-05-23 00:00:00 | |
72606 | CELLTRION USA, INC. | 2021-07-06 00:00:00 | |
72607 | EPIZYME, INC. | 2019-04-05 00:00:00 | |
72611 | ALMAJECT, INC. | 2020-10-26 00:00:00 | |
72618 | BIOHAVEN PHARMACEUTICALS, INC. | 2019-12-27 00:00:00 | |
72626 | ASEGUA THERAPEUTICS LLC | 2022-04-22 00:00:00 | |
72647 | OAKRUM PHARMA, LLC, | 2021-03-01 00:00:00 | |
72664 | VGYAAN PHARMACEUTCIALS | 2021-09-22 00:00:00 | |
72677 | VIELA BIO, INC. | 2021-03-03 00:00:00 | |
72694 | SERVIER PHARMACEUTICALS LLC | 2019-07-23 00:00:00 | |
72730 | QED Therapeutics, Inc. | 2020-04-17 00:00:00 | |
72733 | SANOFI US CORPORATION | 2021-01-21 00:00:00 | |
72769 | BIOCRYST PHARMACEUTICALS, INC. | 2021-02-11 00:00:00 | |
72786 | GLOBAL BLOOD THERAPEUTICS, INC. | 2021-08-04 00:00:00 | |
72819 | Archis Pharma LLC | 2020-01-06 00:00:00 | |
72829 | Rhythm Pharmaceuticals, Inc. | 2022-10-19 00:00:00 | |
72854 | RECKITT BENCKISER, INC. | 2021-02-04 00:00:00 | |
72888 | Advagen Pharma Ltd | 2021-01-13 00:00:00 | |
72893 | ACROTECH BIOPHARMA LLC | 2021-04-15 00:00:00 | |
72912 | ADLON THERAPEUTICS L.P. | 2021-02-25 00:00:00 | |
72928 | Q BIOMED, INC. | 2021-03-16 00:00:00 | |
72974 | Myovant Sciences, Inc. | 2019-06-06 00:00:00 | |
71321 | BRANDYWINE PHARMACEUTICALS | 2020-05-26 00:00:00 | |
73042 | Y-mAbs Therapeutics, Inc | 2020-09-03 00:00:00 | |
73059 | Shield Therapeutics | 2018-07-27 00:00:00 | |
71351 | BROOKFIELD PHARMACEUTICALS, LLC | 2020-01-06 00:00:00 | |
73070 | NOVO NORDISK PHARMA, INC. | 2021-04-07 00:00:00 | |
73077 | Fennec Pharmaceuticals, Inc. | 2022-05-23 00:00:00 | |
73079 | Eiger Biopharmaceuticals Inc. | 2021-10-25 00:00:00 | |
73090 | EUSA Pharma (US) LLC | 2021-10-22 00:00:00 | |
73116 | Secura Bio, Inc. | 2020-10-15 00:00:00 | |
73129 | Origin Biosciences, Inc. | 2021-03-09 00:00:00 | |
73150 | TG THERAPEUTICS, INC. | 2020-09-14 00:00:00 | |
73153 | JUNO THERAPEUTICS, INC. | 2021-12-28 00:00:00 | |
73154 | Ardelyx, Inc. | 2021-11-08 00:00:00 | |
73207 | DECIPHERA PHARMACEUTICALS, LLC | 2020-08-13 00:00:00 | |
73292 | NS PHARMA, INC. | 2021-12-30 00:00:00 | |
73302 | HRA PHARMA AMERICA, INC. | 2021-04-09 00:00:00 | |
73336 | UROVANT SCIENCES, INC. | 2020-11-06 00:00:00 | |
73352 | Trifluent Pharma LLC | 2019-11-05 00:00:00 | |
71767 | SCPHARMACEUTICALS INC. | 2021-06-22 00:00:00 | |
73362 | Ascendis Pharma, Inc. | 2021-08-04 00:00:00 | |
73372 | CLINUVEL, INC | 2022-05-26 00:00:00 | |
73380 | INNATE PHARMA, INC. | 2022-08-25 00:00:00 | |
73462 | G1 THERAPEUTICS INC. | 2021-03-11 00:00:00 | |
73473 | SOLARIS PHARMA CORPORATION | 2021-07-30 00:00:00 | |
73475 | Argenx US, Inc. | 2021-01-08 00:00:00 | |
73521 | Oyster Point Pharma, Inc. | 2022-07-18 00:00:00 | |
73534 | Avalo Therapeutics Inc. | 2022-06-02 00:00:00 | |
73535 | MORPHOSYS US INC. | 2021-01-28 00:00:00 | |
73536 | Pharmaessentia Corporation | 2019-07-16 00:00:00 | |
71993 | ATLAND PHARMACEUTICALS, LLC | 2017-10-27 00:00:00 | |
73556 | ChemoCentryx, Inc. | 2014-06-04 00:00:00 | |
73562 | Nestle Healthcare Nutrition, Inc. | 2013-07-01 00:00:00 | |
73594 | PHARMACOSMOS THERAPEUTICS INC | 2011-09-06 00:00:00 | |
73604 | Kiniksa Pharmaceuticals (UK), Ltd. | 2013-04-18 00:00:00 | |
73606 | APL Sales I LLC | 2012-07-31 00:00:00 | |
73607 | Amivas (US), LLC | 2011-12-05 00:00:00 | |
73625 | MyoKardia, Inc. | 2011-12-14 00:00:00 | |
73683 | Nobelpharma America, LLC | 2011-12-02 00:00:00 | |
74527 | MacroGenics, Inc. | 2012-04-19 00:00:00 | |
74528 | Albireo Pharma, Inc. | 2018-08-01 00:00:00 | |
74676 | Verity Pharmaceuticals Inc. | 2012-04-11 00:00:00 | |
74695 | Mycovia Pharmaceuticals, Inc. | 2013-10-30 00:00:00 | |
74725 | Telix Pharmaceuticals US Inc | 2012-06-21 00:00:00 | |
75626 | AURINIA PHARMA U.S. INC. | 2013-01-22 00:00:00 | |
75788 | SCYNEXIS, INC. | 2012-01-31 00:00:00 | |
75826 | WINDER LABORATORIES, LLC | 2021-05-18 00:00:00 | |
75834 | NIVAGEN PHARMACEUTICALS INC. | 2021-10-08 00:00:00 | |
75854 | AVION PHARMACEUTICALS | 2021-08-23 00:00:00 | |
75987 | HORIZON THERAPEUTICS USA, INC. | 2021-02-09 00:00:00 | |
76045 | FRESENIUS KABI USA, LLC | 2021-10-07 00:00:00 | |
76075 | ONYX PHARMACEUTICAL | 2021-08-11 00:00:00 | |
76125 | KEDRION BIOPHARMA, INC | 2021-05-11 00:00:00 | |
76179 | KEDRION S.p.A. | 2021-04-21 00:00:00 | |
76204 | RITEDOSE PHARMACEUTICALS, LLC | 2022-03-16 00:00:00 | |
76282 | EXELAN PHARMACEUTICALS, INC | 2022-02-25 00:00:00 | |
76329 | INTERNATIONAL MEDICATION SYSTEMS, LTD | 2022-05-03 00:00:00 | |
76336 | HRA PHARMA AMERICA INC. | 2022-08-18 00:00:00 | |
76346 | CORCEPT THERAPEUTICS INCORPORATED | 2021-04-27 00:00:00 | |
76385 | BAYSHORE PHARMACEUTICALS LLC | 2021-04-22 00:00:00 | |
76388 | ASPEN GLOBAL INCORPORATED | 2022-09-02 00:00:00 | |
76431 | AMRYT PHARMACEUTICALS DAC | 2022-02-23 00:00:00 | |
76439 | VIRTUS PHARMACEUTICALS, LLC | 2022-07-25 00:00:00 | |
76478 | Akorn Operating Company LLC | 2022-05-27 00:00:00 | |
77530 | Impel NeuroPharma, Inc. | 2022-09-12 00:00:00 | |
78206 | Organon LLC | 2022-03-30 00:00:00 | |
78670 | USWM, LLC | 2022-08-25 00:00:00 | |
79378 | Mirum Pharmaceuticals, Inc. | 2022-09-20 00:00:00 | |
79802 | Kadmon Pharmaceuticals, LLC | 2022-06-22 00:00:00 | |
79952 | ADC Therapeutics America, Inc. | 2022-01-27 00:00:00 | |
80056 | INTRA-SANA LABORATORIES | 2022-02-23 00:00:00 | |
80203 | Bioverativ U.S. LLC | 2022-10-20 00:00:00 | |
80446 | Immunocore Commercial LLC | 2021-12-16 00:00:00 | |
80491 | Idorsia Pharmaceuticals Ltd | 2022-04-19 00:00:00 | |
80610 | Arcutis Biotherapeutics, Inc. | 2022-03-23 00:00:00 | |
80644 | Zealand Pharma AS | 2022-07-27 00:00:00 | |
80705 | Tripoint Therapeutics | 2022-04-22 00:00:00 | |
80735 | Cipla Therapeutics Inc. | 2020-06-16 00:00:00 | |
72245 | FORTE BIO-PHARMA LLC | 2022-08-19 00:00:00 | |
80803 | Aadi Bioscience, Inc. | 2022-10-26 00:00:00 | |
81092 | BioXcel Therapeutics, Inc. | 2022-03-28 00:00:00 | |
81140 | Protega Pharmaceuticals LLC | 1991-10-01 00:00:00 | |
81284 | Provepharm, Inc. | 2021-10-07 00:00:00 | |
72903 | IMMUNOGEN, INC. | 2022-09-12 00:00:00 | |
81298 | Long Grove Pharmaceuticals, LLC | 2022-03-31 00:00:00 | |
81565 | Phlow Corporation | 2022-08-25 00:00:00 | |
81583 | Marinus Pharmaceuticals Inc | 2022-09-20 00:00:00 | |
81665 | Omnivium Pharmaceutical | 2022-06-22 00:00:00 | |
81672 | Dermavant Sciences Inc. | 2022-12-07 00:00:00 | |
81749 | Calliditas Therapeutics US Inc. | 2022-02-23 00:00:00 | |
81952 | Hepalink USA, Inc. | 2022-10-20 00:00:00 | |
81968 | Axsome Therapeutics, Inc. | 2021-12-16 00:00:00 | |
82009 | Quallent Pharmaceuticals Health | 2022-04-19 00:00:00 | |
82036 | Zambon USA, Ltd | 2022-03-23 00:00:00 | |
82111 | Edenbridge Pharmaceuticals, LLC | 2022-07-28 00:00:00 | |
82154 | zr pharma& GmbH | 2022-04-22 00:00:00 | |
82182 | Pacific Pharma, Inc | 2022-09-26 00:00:00 | |
82249 | CivicaScript, LLC | 2022-08-19 00:00:00 | |
82293 | Novugen Pharma (USA) LLC | 2022-10-26 00:00:00 | |
82429 | Gabar Health Science | 2022-03-29 00:00:00 | |
72989 | ACERTIS PHARMACEUTICALS | 2020-08-20 00:00:00 | |
73063 | AMYLYX PHARMACEUTICALS | 2022-03-28 00:00:00 | |
90096 | Zameer Pharmaceuticals LLC | 2019-10-01 00:00:00 | |
99207 | BAUSCH HEALTH US, LLC | 2009-04-30 00:00:00 | |
13845 | PARSOLEX GMP CENTER, INC. | 2013-07-23 00:00:00 | MDRP participation ends 7/1/2023 |
64253 | MEDEFIL, INC. | 2022-07-25 00:00:00 | MDRP participation ends 7/1/2023 |
73289 | AUCTA PHARMACEUTICALS, INC. | 2021-04-16 00:00:00 | |
73320 | KARTHA PHARMACEUTICALS, INC. | 2021-07-21 00:00:00 | |
73358 | CURAE PHARMA360 INC. | 2012-01-26 00:00:00 | |
73554 | BLUEBIRD BIO, INC. | 2022-09-07 00:00:00 | |
73650 | PROVENTION BIO, INC. | 2022-09-26 00:00:00 | |
76961 | SPECTRUM PHARMACEUTICALS, INC. | 2022-11-16 00:00:00 | |
80739 | MIRATI THERAPEUTICS, INC. | 2023-01-25 00:00:00 | |
81288 | EMC PHARMA, LLC | 2023-02-06 00:00:00 | |
81964 | US ANTIBIOTICS | 2023-01-19 00:00:00 | |
82347 | YARAL PHARMA INC | 2023-02-24 00:00:00 | |
82584 | THEA PHARMA | 2023-01-19 00:00:00 | |
82625 | VALINOR PHARMA, LLC | 2023-04-17 00:00:00 | |
83035 | SINGULAR DREAMER, LTD | 2023-02-24 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 12/30/2022 . 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: 01/3/2023