CMS has rescinded the termination of Lupin (labeler codes 27437, 43386, 68180) from the Medicaid Drug Rebate Program. Claims from Lupin (labeler codes 27437, 43386, 68180) will continue to be payable.
Starting on date of service July 1, 2023, if providers submit a claim with an NDC from one of the labelers listed below, you will receive a denial stating "Product/Service Not Covered." MO HealthNet cannot override this denial. Providers must submit claims for and dispense covered outpatient drugs from manufacturers participating in the MDRP to receive payment. This requirement does not apply to medicines administered in an inpatient setting as part of the inpatient per diem.
Effective July 1, 2023, the Medicaid Drug Rebate Program (MDRP) will no longer include the manufacturers below that have been previously covered. As a result, MO HealthNet will no longer be able to pay claims for these manufacturers for dates of service on and after July 1, 2023, which could affect a significant portion of pharmacy provider claims. It is crucial to be aware of this upcoming modification and prepare in advance by ordering a different manufacturer for MO HealthNet claims processing. MO HealthNet cannot provide overrides for these manufacturers while the manufacturer is excluded from the MDRP.
| Labeler Code (First 5 digits of NDC) |
Labeler Name |
|---|---|
| 50383 | Akorn Operating Company LLC |
| 17478 | Akorn Operating Company LLC |
| 61748 | Akorn Operating Company LLC |
| 49411 | Akorn Operating Company LLC |
| 76478 | Akorn Operating Company LLC |
| 63868 | CHAIN DRUG MARKETING ASSOCIATION, INC |
| 67405 | HARRIS PHARMACEUTICAL, INC. |