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Medicaid National Drug Rebate Agreement (NDRA)

Prior to Requesting an NDRA

Before requesting an NDRA, the labeler code should have at least one drug on the market and available for sale. Make a complete  list of every NDC (11-digit/package size level), including NDCs on the outer package, as well as those on any inner packages. Each NDC must meet the definition of a Covered Outpatient Drug (COD) as defined in section 1927 of the Social Security Act (the Act) and required by the Medicaid Drug Rebate Program (MDRP). Please note that you are not required to include NDCs that represent samples that will not be sold (e.g., products marked as “sample” and provided to a physician at no charge), or NDCs that are not going to be marketed until a future time and/or for which you do not have a marketing start date. Verify that the drugs are listed (or de-listed if any have been discontinued) with the Food and Drug Administration (FDA) on their Comprehensive NDC SPL Data Elements File (NSDE). To verify the status of drug listings, email the Structured Project Labeling (SPL) Coordinator at the FDA at spl@fda.hhs.gov

Manufacturers that wish to participate in the MDRP are required to report all their CODs to CMS, regardless of labeler code. Therefore, in an effort to prevent selective reporting of NDCs, manufacturers must ensure that all associated labeler codes with CODs enter into a rebate agreement in order to comply with the terms of the NDRA. When a participating manufacturer requests an agreement for a newly acquired labeler code that has CODs, that NDRA request will be subject to verification of their proposed COD list. For additional information, please refer to Federal Register 83 FR 12770.

Additionally, manufacturers entering into an NDRA must meet the requirements in section 1927(a)(1) of the Act, requiring compliance with sections 1927(a)(5) and 1927(a)(6). Those sections require that a manufacturer enters into an agreement with the Public Health Service that satisfies section 340B of the Public Health Service Act, and, enters into a master agreement with the Secretary of Veterans Affairs.

Manufacturers participating in the MDRP are required to have a Technical, Invoice, and Legal Contact with mailing addresses in the United States (U.S.) or U.S. Territories.  Mailing addresses that are forwarding services outside of the U.S. or U.S. Territories are not permitted. Please note that the final part of the rebate agreement request process will require that official contact information be submitted. If the contact information provided at that time does not comply with this requirement, a final rebate agreement may not be executed.

Requesting an NDRA for a New Labeler Code

New NDRA requests are for labeler codes that have not previously participated in the MDRP. To request an NDRA:

Requesting an NDRA Reinstatement for a Terminated Labeler Code

NDRA Reinstatement requests are for terminated labeler codes that have previously participated in the MDRP.  To request a reinstatement, please refer to the Reinstatement section of the NDRA Reference Guide (PDF, 40.03 KB).

NDRA Optional and Mandatory Effective Dates 

The Balanced Budget Refinement Act of 1999 amended section 1927(a)(1) of the Act to give states the option of using a different rebate agreement effective date than the date that was required prior to the amendment.  Specifically, the law permits that a rebate agreement may become effective as of the date on which the agreement is entered into (referred to as the Optional Effective Date (OED)) or, at the State’s option, on any date thereafter on or before the first day of the calendar quarter that begins more than 60 days after the agreement is entered into (referred to as the Mandatory Effective Date (MED)).

Effective Date Type Start Date What It Means
Optional Effective Date Starts the date that the signed and completed NDRA has been received and accepted by CMS via the MDP system. Note: NDRAs that are emailed, faxed, or mailed, are not a valid means of submissions to CMS and will not be accepted. States can (at their option) cover the manufacturer's drugs as of this date.
Mandatory Effective Date Starts on the first day of the calendar quarter that begins more than 60 days after the date the agreement is entered into. States must generally cover a manufacturer's drugs as of this date (subject to the exceptions in section 1927 of the Social Security Act).

Examples of Optional and Mandatory Effective Dates Once the Rebate Agreement Has Been Received and Accepted by CMS

Manufacturer X uploads a signed and completed rebate agreement on January 15th,

  • The Optional Effective Date for Manufacturer X's rebate agreement is January 15th.
  • The Mandatory Effective Date for Manufacturer X's rebate agreement is the first day of the calendar quarter that begins more than 60 days after the date the agreement is entered into. Sixty days after January 15th is March 16th and the next complete quarter that occurs after that date is the second quarter; therefore, the Mandatory Effective Date for Manufacturer X's rebate agreement is April 1st.

Generally, the last date on which a new manufacturer's rebate agreement can be accepted to establish the mandatory state coverage date each quarter (in a non-leap year) is as follows:

For a Mandatory Effective Date of: The Rebate Agreement Must Be Received And Accepted by CMS by
1st Quarter  (i.e., January 1st) November 1
2nd Quarter (i.e., April 1st) January 30
3rd Quarter (i.e., July 1st) May 1
4th Quarter (i.e., October1st) August 1

To view new/reinstated and terminated labelers within the past two quarters, please see the New/Reinstated & Terminated Labeler Information page.

Reporting Requirements

The terms of the NDRA require that initial product and pricing information be submitted and certified on all participating manufacturer’s CODs within 30 days of the end of the month and quarter of the OED. For every month and quarter thereafter, pricing data are due within 30 days of the end of each respective monthly and quarterly period and updated as often as necessary. In addition, product data should be initially reported and/or updated as soon as it is available. When a manufacturer markets a new COD, the drug must also be reported to CMS ensuring that it is first electronically listed with the FDA.

If you have any questions, please contact DrugRebateAgreement@CMS.HHS.gov

Disclaimer: Please note that the information provided on this web page does not bind or obligate the Centers for Medicare and Medicaid Services (CMS). The statements included on this web page are intended to provide information on the Medicaid National Drug Rebate Agreement (NDRA) and do not in any way revise or modify the requirements set forth in Section 1927 of the Act, the national drug rebate agreement (NDRA), subsequent program releases, or regulations.

Page last updated on September 2, 2020