Frequently Asked Questions

Per the state drug utilization data table, the "Dataset Views" dropdown selections available are:

• State: State-specific data at the NDC-11 level, for a quarter/year.
• Full Dataset (States + National Totals): A compilation of all the individual state utilization data (50 states plus Washington D.C.) and the National Totals at the NDC-11 level, for a selected year.
• All States: Includes data for all states but does not include the National Totals
• National Totals: Data are aggregated for all 50 states and Washington, D.C. at the NDC-11 level, for a quarter/year.

Since all of the states are combined in the National Totals, the state abbreviation will show on the "Annual State Detail" with a state abbreviation of "XX".

Users can also generate his or her own views of the dataset on data.medicaid.gov.

FAQ ID:91786

You are likely running into a limitation of the program you are trying to use to analyze the data. Microsoft Excel allows 1,048,576 rows of data and many of our datasets exceed this limit.

We recommend users not use Excel for large datasets but instead use another application that can work with datasets of large size (e.g. Microsoft Access).

FAQ ID:91801

Since all of the states are combined in the National Totals, the state abbreviation will show on the "National Totals" and "Annual State Detail" option as "XX".

See Also:

• What are the data field descriptions for the State Drug Utilization Data (SDUD)?

FAQ ID:91811

As CMS is obligated by the Federal Privacy Act, 5 U.S.C. Section 552a and the HIPAA Privacy Rule, 45 C.F.R Parts 160 and 164, to protect the privacy of individual beneficiaries and other persons, all direct identifiers have been removed and data that are less than eleven (11) counts are suppressed. An asterisk (*) notes suppressed data. CMS applies counter or secondary suppression in cases where only one prescription is suppressed for primary reasons, e.g. one prescription in a state. Also, if one sub-group (e.g. number of prescription) is suppressed, then the other sub-group is suppressed.

See Also:

• What fields changed when CMS moved the State Drug Utilization Data (SDUD) to data.medicaid.gov?
• What are the data field descriptions for the State Drug Utilization Data (SDUD)?
• Is the redacted State Drug Utilization Data (SDUD) available to the public?

FAQ ID:91831

No. In accordance with federal laws, State Drug Utilization Data (SDUD) that has been suppressed is not available for public consumption.  As CMS is obligated by the Federal Privacy Act, 5 U.S.C. Section 552a and the HIPAA Privacy Rule, 45 C.F.R Parts 160 and 164, to protect the privacy of individual beneficiaries and other persons, all direct identifiers have been removed and data that are less than eleven (11) counts are suppressed. A checkmark in the "Suppression Used" column notes suppressed data. CMS applies counter or secondary suppression in cases where only one prescription is suppressed for primary reasons, (e.g., one prescription in a state). Also, if one sub-group (e.g., number of prescriptions) is suppressed, then the other sub-group is suppressed.

FAQ ID:91856

If the data arrives late, it may miss the quarterly posting. However, it will be included in the next quarter's web posting.

FAQ ID:91916

For current versions of MDRP File Formats/Data Definitions, please refer to: https://www.medicaid.gov/medicaid/prescription-drugs/medicaid-drug-rebate-program/medicaid-drug-rebate-program-mdrp-file-formats-data-definitions-and-medicaid-drug-programs-mdp-email-communications/index.html

See Also:

• What fields changed when CMS moved the State Drug Utilization Data (SDUD) to data.medicaid.gov?
• Is the redacted State Drug Utilization Data (SDUD) available to the public?

FAQ ID:91956

The regulation only prohibits insurance policies that would be sold ""in conjunction with"" enrollment in the Medicaid managed care plan. Section 438.104 alone does not prohibit a Medicaid managed care plan from providing information about a Qualified Health Plans (QHP) to potential enrollees who could enroll in such a plan as an alternative to the Medicaid managed care plan due to a loss of Medicaid eligibility or to potential enrollees who may consider the benefits of selecting an Medicaid managed care plan that has a related QHP in the event of future eligibility changes. However, Medicaid managed care plans should consult their contracts and the State Medicaid agency to ascertain if other provisions exist that may prohibit or limit such activity.

Section 438.104(b)(1)(iv) implements a provision in section 1932(d)(2)(C) of the Social Security Act, titled ""Prohibition of Tie-Ins."" In promulgating regulations implementing this provision, CMS clarified that we interpreted it to preclude tying enrollment in the Medicaid managed care plan with purchasing (or the provision of) other types of private insurance. We do not intend the statutory prohibition of tie-ins to apply to a discussion of a possible alternative to the Medicaid managed care plan, which a QHP could be if the consumer is determined to be not Medicaid eligible or loses Medicaid eligibility.

Supplemental Links:

• This FAQ was released as part of a larger set. View the full set. (PDF, 138.58 KB)

FAQ ID:94351

States are encouraged to review their managed care contracts to clearly identify the legal entity with which they are contracted for Medicaid coverage since federal Medicaid managed care regulations do not address this aspect of contracting. If the party to the contract is an entity (such as a parent company) that has a contract with a state Medicaid agency to provide benefits as a Medicaid managed care plan and is also a QHP issuer, then some contractual provisions may apply to both. Although the federal Medicaid regulations do not apply to a QHP issuer or QHP, state law, regulation, or contract language may have implications for the QHP issuer. If changes are needed to narrow the scope of the contract to apply only to the Medicaid managed care plan, we encourage states to make those changes so as to ensure consistent understanding and application of the Medicaid contract terms.

Supplemental Links:

• This FAQ was released as part of a larger set. View the full set. (PDF, 138.58 KB)

FAQ ID:94371

Yes. Responding to direct questions from consumers is not generally a violation of 42 CFR 438.104. Proactive consumer inquiries to a health plan for information about coverage options, benefits, or provider networks is no different than a consumer obtaining information from the health plan's website. So long as the limits on marketing are satisfied and respected (e.g., the information is accurate and does not mislead, confuse or defraud beneficiaries or the state Medicaid agency), responding to direct questions from potential enrollees with accurate information is not prohibited.

Supplemental Links:

• This FAQ was released as part of a larger set. View the full set. (PDF, 138.58 KB)

FAQ ID:94391