Medicare Part B Drugs Without a Medicaid National Drug Rebate Agreement

Manufacturers of outpatient drugs covered under Medicare Part B must have entered into, and have in effect, a Medicaid National Drug Rebate Agreement (NDRA) for payment to be available. Some single source drugs, biologicals, and radiopharmaceuticals do not have a Medicaid NDRA in effect at the time this article is written.

Medicare Administrative Contractors have been instructed to deny line items for HCPCS codes describing products whose manufacturers did not promptly enter into a Medicaid NDRA for their covered outpatient drugs effective for dates of service beginning April 1, 2026. The drugs that are non-payable under Medicare Part B due to the manufacturer not having a Medicaid NDRA in effect are listed in the Medicare Part B Drug Payment Limit Files.