The Deficit Reduction Act of 2005 (DRA) required states, based on the dates indicated below, to collect and submit utilization data and coding for single source and certain high dollar volume multiple source covered outpatient physician administered drugs in order for payment to be available under Medicaid and to secure Medicaid drug manufacturer rebates.
Beginning January 1, 2006, in order for Medicaid payment to be available, states must collect and submit utilization data for single source, covered outpatient physician administered drugs in order to secure rebates for such drugs. Effective January 1, 2007, states must also collect National Drug Codes (NDC) for certain multiple source covered outpatient physician administered drugs. Similarly, beginning January 1, 2008, in order for Medicaid payment to be available, states must collect and submit utilization data and coding for certain high dollar volume multiple source covered outpatient physician administered drugs in order to receive federal matching funds and secure drug manufacturer rebates for such drugs.
The Secretary's published list of the top 20 multiple source covered outpatient physician administered drugs are ranked in order of highest cost and volume in the Medicaid program. The list provides the Healthcare Common Procedure Coding System (HCPCS) codes for each listed drug. States must collect NDC information on these drugs in order to receive federal matching funds and secure manufacturer rebates. In accordance with section 1927(a)(7)(B)(i) of the Social Security Act, the updated list of the top 20 multiple source physician administered drugs with the highest Medicaid dollar volume can be found at this link (PDF, 122.78 KB). The law allows us to modify the current list to reflect changes in such volume.
In summary, beginning January 1, 2006, for single source physician administered drugs, and January 1, 2008 for certain multiple source physician administered drugs, if states are not collecting NDCs and submitting the appropriate utilization data, such states will not receive Federal matching payments for the drugs. CMS acknowledges that most states require their providers and managed care organizations to collect NDC information on multiple source covered outpatient drugs to invoice for rebates and expect that this practice will continue. For further information on this part of the DRA, please see the SMD letter on physician-administered drugs (PDF, 75.81 KB).
PRA Disclosure Statement: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1026 (Expires: August 31, 2024). The time required to complete this information collection of National Drug Codes (NDC) for physician-administered drugs is estimated 0.00415 hrs/claim resulting in $0.17/claim. If you have comments concerning the accuracy of the time estimate or suggestions for improving this form, please write to CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.
Questions regarding the topics on this page? Email RxDrugPolicy@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 State Prescription Drug Resources 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 October 20, 2022