Frequently Asked Questions are used to provide additional information and/or statutory guidance not found in State Medicaid Director Letters, State Health Official Letters, or CMCS Informational Bulletins. The different sets of FAQs as originally released can be accessed below.
Frequently Asked Questions
Regarding State Drug Utilization Data (SDUD), are all states required to report from the same National Drug Code (NDC) list or can they make their own requirements for reporting?
In general, all states cover all drugs (that meet the statutory definition of a covered outpatient drug per section 1927 of the Social Security Act (the Act)) of every manufacturer that participates in the Medicaid Drug Rebate Program (MDRP). However, section 1927(d)(2) of the Act does list several categories of drugs that states may, at their option, exclude or restrict from coverage under the MDRP. These categories include things like non-prescription drugs, drugs used for cosmetic purposes, etc. Therefore, while most states cover the same subset of drugs, there is some flexibility afforded to the states which can result in coverage differences from one state to the next.
FAQ ID:92066
SHARE URLIs state-only utilization included in the State Drug Utilization Data (SDUD)?
State-only program utilization (e.g. ADAP) should not be included in the Federal State Medicaid Drug Rebate Program.
FAQ ID:92071
SHARE URLRegarding State Drug Utilization Data (SDUD), is there a National Drug Code (NDC) / Product List that each state should follow? If so, where is this located?
Each quarter, a drug product listing is available from the approximately 45 days after the close of the quarter. This information contains the active drugs that have been reported for inclusion in the Medicaid Drug Rebate Program (MDRP) by participating drug manufacturers as of the most recent rebate reporting period.
FAQ ID:92076
SHARE URLRegarding State Drug Utilization Data (SDUD), is there an official crosswalk of National Drug Code (NDC) and Healthcare Common Procedure Coding System (HCPCS) codes which providers can use?
The drug utilization data that states report to CMS is reported at the NDC level. Therefore, for purposes of the Medicaid Drug Rebate Program (MDRP), crosswalk from HCPCS code to NDC should have already occurred prior to the states reporting their drug utilization data to CMS. Medicare Part B does post a HCPCS to NDC crosswalk ; however, please note that the subset of drugs covered under Part B is much smaller than the drugs covered under the MDRP. Therefore, you may not find this crosswalk to be all-inclusive of every product covered under the MDRP.
FAQ ID:92081
SHARE URLAre 340B claims included in State Drug Utilization Data (SDUD)?
States should identify and exclude 340B claims from 340B providers before submitting their state drug utilization data to CMS.
FAQ ID:92086
SHARE URLAre drugs used in hospital outpatient settings excluded from the Medicaid Drug Rebate Program?
If a covered outpatient drug is billed as an outpatient drug and not part of a bundled service, it is rebate-eligible.
FAQ ID:92091
SHARE URLI noticed a discrepancy in the State Drug Utilization Data (SDUD), what do I do?
Should you notice apparent discrepancies in an individual state's utilization data, your questions should be directed to the State Technical Contact.
FAQ ID:92096
SHARE URLHow often are the State Drug Utilization Data (SDUD) and the National Summary Utilization Data updated and posted to the website?
The Centers for Medicare & Medicaid (CMS) posts updated State Drug Utilization Data (SDUD) according to the following schedule:
- 1st Quarter (plus 5 preceding years of data): Available in August, and includes any late data reporting for 1st Quarter received from States through the end of June, plus any updates to the five preceding years of data.
- 2nd Quarter (plus 5 preceding years of data): Available in November, and includes any late data reporting for 2nd Quarter received from States through the end of September, plus any updates to the 5 preceding years of data.
- *3rd Quarter (update of all preceding years): Available in February, and includes any late data reporting for 3rd Quarter received from States through the end of December, plus any updates to the five preceding years of data.
- 4th Quarter (plus 5 preceding years of data): Available in May, and includes any late data reporting for 4th Quarter received from States through the end of March, plus any updates to the five preceding years of data.
*An update of all preceding years of State Drug Utilization Data (1991 to 3rd Quarter) are posted to the website annually during the month of February. The data posted includes utilization information received from States through the end of December. The National Totals represent aggregate data by NDC-11.
See Also: With regards to State Drug Utilization Data (SDUD), is the data for each quarter's posting always comprehensive?
FAQ ID:92101
SHARE URLDoes the State Drug Utilization Data (SDUD) reported for each quarter's posting always include all of the quarterly data reported by states?
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
SHARE URLWhat are the data field descriptions for the State Drug Utilization Data (SDUD)?
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
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