NCTracks
Attention: Pharmacy Providers Coverage for Prilosec OTC® Terminates April 1, 2016 - Update
Drug manufacturers are required to enter into, and have in effect, a national rebate agreement with the Secretary of the Department of Health and Human Services (HHS) in exchange for state Medicaid coverage of the drugs they manufacturer. The Centers of Medicare and Medicaid Services (CMS) has notified NC Medicaid that Proctor & Gamble Distributing, LLC (P&G) has terminated their federal rebate agreement with an effective date of March 31, 2016.
Therefore, NC Medicaid will terminate coverage for the Prilosec® OTC NDCs below effective April 1, 2016 and pharmacy claims submitted after March 31, 2016 will deny.
|
DRUG NAME |
NDC |
|
PRILOSEC® OTC 20 MG TABLET |
37000005845 |
|
PRILOSEC® OTC 20 MG TABLET |
37000045505 |
|
PRILOSEC® OTC 20 MG TABLET |
37000046513 |
|
PRILOSEC® OTC 20.6 MG TABLET |
37000035905 |
|
PRILOSEC® OTC 20.6 MG TABLET |
37000035906 |
|
PRILOSEC® OTC 20.6 MG TABLET |
37000035907 |
|
PRILOSEC® OTC 20.6 MG TABLET |
37000045502 |
|
PRILOSEC® OTC 20.6 MG TABLET |
37000045503 |
|
PRILOSEC® OTC 20.6 MG TABLET |
37000045504 |
|
PRILOSEC® OTC 20.6 MG TABLET |
37000045902 |
|
PRILOSEC® OTC 20.6 MG TABLET |
37000045903 |
|
PRILOSEC® OTC 20.6 MG TABLET |
37000045904 |
|
PRILOSEC® OTC 20.6 MG TABLET |
37000080836 |
|
PRILOSEC® OTC 20.6 MG TABLET |
37000080934 |
|
PRILOSEC® OTC 20.6 MG TABLET |
37000080935 |
NC Medicaid will continue coverage for the omeprazole OTC NDCs below since their manufacturers have an active federal rebate agreement.(Note: This is an updated list from the one published on March 24, 2016.)
|
DRUG NAME |
NDC |
|
OMEPRAZOLE DR 20 MG TABLET |
00113091530 |
|
OMEPRAZOLE DR 20 MG TABLET |
00113091555 |
|
GS OMEPRAZOLE DR 20 MG TABLET |
00113091574 |
|
OMEPRAZOLE DR 20 MG TABLET |
00904583441 |
|
OMEPRAZOLE DR 20 MG TABLET |
00904583442 |
|
OMEPRAZOLE DR 20 MG TABLET |
00904583471 |
|
SB OMEPRAZOLE DR 20 MG TABLET |
15127002120 |
|
SB OMEPRAZOLE DR 20 MG TABLET |
15127002121 |
|
SB OMEPRAZOLE DR 20 MG TABLET |
15127002123 |
|
SB OMEPRAZOLE DR 20 MG TABLET |
15127090314 |
|
SB OMEPRAZOLE DR 20 MG TABLET |
15127090328 |
|
SB OMEPRAZOLE DR 20 MG TABLET |
15127090342 |
|
OMEPRAZOLE DR 20 MG TABLET |
36800091501 |
|
OMEPRAZOLE DR 20 MG TABLET |
36800091503 |
|
OMEPRAZOLE DR 20 MG TABLET |
36800091530 |
|
OMEPRAZOLE DR 20 MG TABLET |
36800091555 |
|
OMEPRAZOLE DR 20 MG TABLET |
36800091574 |
|
OMEPRAZOLE DR 20 MG TABLET |
37205083706 |
|
OMEPRAZOLE DR 20 MG TABLET |
37205083715 |
|
OMEPRAZOLE DR 20 MG TABLET |
37205083766 |
|
OMEPRAZOLE DR 20 MG TABLET |
37205083774 |
|
OMEPRAZOLE DR 20 MG TABLET |
45802088830 |
|
OMEPRAZOLE DR 20 MG TABLET |
45802088855 |
|
OMEPRAZOLE DR 20 MG TABLET |
46122002903 |
|
OMEPRAZOLE DR 20 MG TABLET |
46122002904 |
|
OMEPRAZOLE DR 20 MG TABLET |
46122002974 |
|
OMEPRAZOLE DR 20 MG TABLET |
46122002999 |
|
SM OMEPRAZOLE DR 20 MG TABLET |
49348084646 |
|
SM OMEPRAZOLE DR 20 MG TABLET |
49348084661 |
|
SM OMEPRAZOLE DR 20 MG TABLET |
49348084678 |
|
OMEPRAZOLE MAG DR 20.6 MG CAP |
55111039727 |
|
OMEPRAZOLE MAG DR 20.6 MG CAP |
55111039752 |
|
HM OMEPRAZOLE DR 20 MG TABLET |
62011015701 |
|
HM OMEPRAZOLE DR 20 MG TABLET |
62011015702 |
|
HM OMEPRAZOLE DR 20 MG TABLET |
62011015703 |
|
OMEPRAZ MAG 20 MG CAPCDMA |
63868017742 |