Medicaid Drug Rebate Program Data
Product Data for Drugs in the Medicaid Drug Rebate Program
The rebate drug product data file [ZIP] contains the active drugs that have been reported by participating drug manufacturers as of the most recent rebate reporting period under the Medicaid Drug Rebate Program. All drugs are identified by National Drug Code (NDC), unit type, units per package size, product name, Food and Drug Administration (FDA) approval date, the date the drug entered the market, plus indicators to show whether the drug is an innovator or non-innovator drug; whether it is available by prescription or over-the-counter (OTC); the FDA therapeutic equivalency code; and the Drug Efficacy Study Implementation (DESI) rating and termination date, if applicable. (Note: Only active drugs and drugs with a termination date on or after the last processed quarter are included in the file). For your convenience, we are also providing you the record specification and definitions for the drug product data file [PDF].
Quarterly Average Manufacturer Price (AMP) Data for Drugs in the Medicaid Drug Rebate Program: Reported or Not Reported
In accordance with the terms of the National Drug Rebate Agreement and section 1927(b)(3)(A) of the Social Security Act (the Act), drug manufacturers participating in the Medicaid Drug Rebate Program are required to report AMP information to the Centers for Medicare & Medicaid Services (CMS) each quarter. A quarterly AMP must be reported for each active drug that the manufacturer has reported for inclusion in the Medicaid Drug Rebate Program. Failure to submit the required AMP data may result in penalties, such as the drug manufacturer’s termination from the rebate program or the issuance of civil monetary penalties by the Office of the Inspector General.
In an effort to improve the timeliness of the data CMS receives from drug manufacturers each quarter, CMS is posting the quarterly AMP reported or not reported file [ZIP]. This file contains the active drugs that have been submitted as of the most recent reporting period under the Medicaid Drug Rebate Program, along with an indication of whether or not the required AMP was reported for each drug. All drugs are identified in the file by the 11-digit National Drug Code (NDC), product name, labeler name, and reported (R) or not reported (NR). Please note that, due to confidentiality provisions found in section 1927(b)(3)(D) of the Act, this file does not contain actual AMP values; rather, it simply notes whether or not CMS received an AMP for each drug included in the file. Further, the file only reflects AMP data that was received at the time that Medicaid drug rebates were calculated for the most recent reporting period. Finally, the only terminated drugs included in this file are those that are being terminated within the quarter represented in the file, or those with a termination date in the future.
State Utilization Data
Drug utilization for States are available for covered outpatient drugs paid for by State Medicaid agencies since the start of the Medicaid Drug Rebate Program. To download these data, please use the State drug utilization data specifications [PDF].
Please note that this format includes two new fields: Medicaid Amount Reimbursed and Non-Medicaid Amount Reimbursed. The sum of these two fields should generally equal the Total Amount Reimbursed on an NDC by NDC basis; however, these new fields were implemented beginning with the fourth quarter of 2007 and are optional for the states to report prior to that time. Therefore, for quarters earlier than fourth quarter 2007, there may be some large discrepancies between the Total Amount Reimbursed and the sum of the Medicaid Amount Reimbursed and the Non-Medicaid Amount Reimbursed because the Non-Medicaid Amount Reimbursed is often not present for those earlier quarters. Should you notice apparent discrepancies in an individual state's utilization data, your questions should be directed to that state's Technical Contact.
How often are the State Utilization Data and the National Summary Utilization Data [Dynamic List - ZIP] updated and posted to the website?
1st Quarter (plus 5 preceding years of data): August
2nd Quarter (plus 5 preceding years of data): November
3rd Quarter (plus 5 preceding years of data): February
4th Quarter (plus 5 preceding years of data): May
State utilization data older than the current quarter plus five previous years of data are updated annually and posted to the website during the month of February. The national summary utilization data are aggregate data by NDC-11.
Last Update: August Cycle - 1st Quarter (plus 5 preceding years of data):
Questions about the Medicaid Drug Rebate Program's data? Email MDROperations@cms.hhs.gov.
Page last updated on 8/14/2012