Medicaid Drug Rebate Program Data

Product Data for Drugs in the Medicaid Drug Rebate Program

The rebate drug product data contains the active drugs that have been reported by participating drug manufacturers as of the most recent rebate reporting period under the Medicaid Drug Rebate Program. All drugs are identified by the following data fields:

  • Labeler Name
  • National Drug Code (NDC)
  • Drug Category (to identify whether a drug is an innovator or non-innovator)
  • Drug Type (to identify whether a drug is available by prescription or over-the-counter (OTC))
  • Termination Date (if applicable)
  • Unit Type
  • Units Per Package Size
  • Food and Drug Administration (FDA) Approval Date
  • Market Date
  • FDA Therapeutic Equivalency Code
  • Product Name
  • Clotting Factor/Exclusively Pediatric Indicator
  • Package Size Intro. Date
  • Purchased Product Date
  • Covered Outpatient Drug (COD) status (which replaces the Drug Efficacy Study Implementation (DESI) rating)
  • FDA Application Number/OTC Monograph Number
  • Reactivation Date (if applicable)

You may refer to the data definitions for more information regarding the valid values for each of these fields. Please click on the link to access  the web file structure and data definitions for the drug product data file.

The drug product data file contains individual files for the current quarter plus the previous eight quarters. Please save and archive these files, including the file format, for any future use you may have as we do not archive these files once posted and cannot honor individual requests for regenerated files. (Note: Only active drugs and drugs with a Termination Date within or after the last processed quarter are included in the file).

If you have any questions, please contact us at MDROperations@cms.hhs.gov.

Quarterly Average Manufacturer Price (AMP) Data for Drugs in the Medicaid Drug Rebate Program: Reported or Not Reported

In accordance with the terms of the National Drug Rebate Agreement and section 1927(b)(3)(A) of the Social Security Act (the Act), drug manufacturers participating in the Medicaid Drug Rebate Program are required to report AMP information to the Centers for Medicare & Medicaid Services (CMS) each quarter. A quarterly AMP must be reported for each active drug that the manufacturer has reported for inclusion in the Medicaid Drug Rebate Program. Failure to submit the required AMP data may result in penalties, such as the drug manufacturer’s termination from the rebate program or the issuance of civil monetary penalties by the Office of the Inspector General.

In an effort to improve the timeliness of the data CMS receives from drug manufacturers each quarter, CMS is posting the quarterly AMP reported or not reported file. This file contains the active drugs that have been submitted as of the most recent reporting period under the Medicaid Drug Rebate Program, along with an indication of whether or not the required AMP was reported for each drug. All drugs are identified in the file by the 11-digit National Drug Code (NDC), product name, labeler name, and reported (R) or not reported (NR). Please note that, due to confidentiality provisions found in section 1927(b)(3)(D) of the Act, this file does not contain actual AMP values; rather, it simply notes whether or not CMS received an AMP for each drug included in the file. Further, the file only reflects AMP data that was received at the time that Medicaid drug rebates were calculated for the most recent reporting period. Finally, the only terminated drugs included in this file are those that are being terminated within the quarter represented in the file, or those with a termination date in the future.

State Utilization Data

Drug utilization for States are available for covered outpatient drugs paid for by State Medicaid agencies since the start of the Medicaid Drug Rebate Program. The reported data includes two fields: Medicaid Amount Reimbursed and Non-Medicaid Amount Reimbursed. The sum of these two fields should generally equal the Total Amount Reimbursed on an NDC by NDC basis; however, these fields were implemented beginning with the fourth quarter of 2007 and are optional for the states to report prior to that time. Therefore, for quarters earlier than fourth quarter 2007, there may be some large discrepancies between the Total Amount Reimbursed and the sum of the Medicaid Amount Reimbursed and the Non-Medicaid Amount Reimbursed because the Non-Medicaid Amount Reimbursed is often not present for those earlier quarters. Should you notice apparent discrepancies in an individual state's utilization data, your questions should be directed to that state's Technical Contact.

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.

How often are the State Utilization Data and the National Summary Utilization Data updated and posted to the website?

  • 1st Quarter (plus 5 preceding years of data): Available August (includes data received from States through the end of June)
  • 2nd Quarter (plus 5 preceding years of data): Available November (includes data received from States through the end of September)
  • 3rd Quarter (full update of all preceding years): Available February (includes data received from States through the end of December)
  • 4th Quarter (plus 5 preceding years of data): Available May (includes data received from States through the end of March)

State utilization data older than the current quarter plus five previous years of data are updated annually and posted to the website during the month of February (the data posted includes utilization information received from States through the end of December). The national summary utilization data are aggregate data by NDC-11.

Questions about the Medicaid Drug Rebate Program's data? Email MDRUtilization@cms.hhs.gov.

Page Last updated on May 16, 2017