Not Using NDC Numbers on Medicaid Claims? Start NOW

If you're not already doing so, start including National Drug Code (NDC) numbers on your Medicaid fee-for-service and HMO claims for prescription drugs because Texas will begin enforcing the provision on Jan. 1, 2014. The requirement applies to all outpatient prescription drugs, except vaccines, and to long-acting reversible contraceptives.

Beginning on Jan. 1,  if a drug manufacturer does not participate in the federal prescription drug rebate program, Medicaid will no longer pay for the drug. TMA requested an extension of the enforcement deadline, but HHSC turned down the request, citing the fiscal implications to the state if it failed to comply by Jan. 1.

A list of rebate program NDC codes is on the Centers for Medicaid & Medicare Services (CMS) website. 

 The Health and Human Services Commission will conduct a webinar on Friday, Dec.  20, from 1 to 2:30 pm CT to discuss the NDC requirement and answer your questions. Registration is required.

The federal Deficit Reduction Act of 2005 requires professional and outpatient hospital claims to include the NDC numbers for physician-administered drugs so that the state and federal governments can increase collections of pharmaceutical rebates. Texas implemented the provision in 2008, though until recently, the provision had not been strictly enforced. An audit conducted by CMS revealed that lack of compliance by Texas had resulted in the state and federal governments losing millions of dollars.

For frequently asked questions and answers about the NDC requirement, a crosswalk of NDC to HCPCS codes, and a link to files containing the NDC number by product, visit the Texas Medicaid & Healthcare Partnership website.     


Action, Dec. 16, 2013


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