Medicaid Drug Rebate Program (MDRP) billing requirement for pharmacy claims
Governs billing eligibility for Medicaid pharmacy claims for Neighborhood Health Plan of Rhode Island members, requiring drugs to be manufactured or distributed by labelers participating in the federal Medicaid Drug Rebate Program; does not apply to Neighborhood Commercial or INTEGRITY plans.
No material clinical or coverage changes in this revision.
Medicaid Drug Rebate Participation Requirements
MDRP billing criteria and remediation
Conditions under which Medicaid pharmacy claims will be processed or rejected:
If prescribed product is a brand-name medication
- Prescriber should identify and prescribe a comparable alternative from a participating labeler.
If prescribed product is a generic medication
- Dispensing pharmacy should reprocess the claim using the same generic product from a manufacturer that participates in the rebate agreement.
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