Physician Administered Drugs

September 24, 2012

Under the Medicaid Drug Rebate Program, manufacturers are required to provide rebates for drugs that a state pays for. To receive rebates, states must identify the drugs by their National Drug Code (NDC). The Department requires providers to submit the NDC on claims with the correct J-Code. You can view the NDC/HCPCS Crosswalk the Department uses to verify this information on the Pricing, Data Analysis and Coding webpage.

This list does not provide the rebate drug product list. Please speak with the pharmacy or wholesaler that you work with to ensure you are able to get a rebate for a drug before you purchase it. You can view the rebate drug product list on the Centers for Medicare and Medicaid Services (CMS) website. Drugs from participating manufacturers are listed by NDC, as well as other criteria.

In order to receive payment for a drug without a rebate, you must have Prior Authorization from MaineCare. The claim line will deny if the NDC does not match the J-Code or if the NDC is not on the Rebate Drug List.