Centers for Medicare & Medicaid Services
Key lines of business for the Centers for Medicare &
Medicaid Services (CMS) are the following:
- Medicare health plans
- Medicare financial management
- Medicare fee-for-service operations
- Medicaid and children's health survey, certification, and
quality improvement
CMS Deleted Products
The CMS Deleted Products memoranda include instructions sent to
the state Medicaid directors concerning the Medicaid product
coverage. The U.S. Food and Drug Administration (FDA) and the CMS
have jointly determined that the following drugs/products lack
approved applications and as a result, do not meet the definition
of a "covered outpatient drug" under Medicaid programs.
Consequently, as of the date of the notification, the drugs and
products are no longer covered by Indiana Medicaid.
-
Eldertonic Multivitamin Mineral Supplement -- December 5,
2011
-
Hydrocortisone Acetate Suppository 25mg -- November 17,
2011
-
Tropazone Lotion/Tropazone CR (Tropazone Cream) -- October 7,
2011
- Mykidz Iron
10 -- July 25, 2011
- Hylatopic/Hylatopic Plus -- June
20, 2011
- Extended Release
Hyoscyamine Products -- June 2, 2011
- Cough,
Cold, and Allergy Drug Products -- May 4, 2011
- Pruvel
Cream -- December 9, 2010
- Darvon/Darvocet --
November 19, 2010
- Colchicine
0.6mg Tablets -- November 16, 2010
- Prutect/Pruclair --
November 16, 2010
- Colchicine
0.6mg Tablets -- October 21, 2010
State Releases
The CMS State Releases include every
note and instruction sent to the state Medicaid directors
concerning the Medicaid drug rebate program. The releases are
archived back to 1991.
desi drug list
The Federal Food, Drug, and Cosmetics Act of 1938 established
the requirement that a manufacturer prove the safety of a drug
before it could be marketed in the United States. In 1962, this act
was amended to require that drugs sold in the United States be
regulated more closely.
All new drugs must demonstrate, via adequate studies, safety and
efficacy before introduction into the market. The Drug Efficacy
Study Implementation (DESI) Program was established to ensure that
drugs that did not have proven efficacy were ultimately removed
from the market and not reimbursed by state Medicaid programs in
the interim.
Federal law prohibits state Medicaid agencies from reimbursing
for so-called less than effective (LTE) drugs, commonly called DESI
drugs, or any drug that the federal government has determined to be
identical, related, or similar (IRS) to such a drug. These drugs
are not covered by the Indiana Health Coverage Programs (IHCP), and
providers are not entitled to reimbursement.
If you have a question about a specific drug's current DESI
indicator, contact HP Customer Assistance at (317) 655-3240 in the
Indianapolis local area or toll-free at 1-800-577-1278.
Drug Rebate Labeler
Federal law requires that, for legend or nonlegend drugs to be
covered by state Medicaid programs, the manufacturer must have a
drug rebate agreement in effect with the CMS.
A complete list of manufacturers by labeler number -- the first
five digits of the National Drug Code (NDC) -- that have entered
into a rebate agreement with the federal government is available at
www.CMS.gov. It is
essential that pharmacies check this list for the status of a drug
manufacturer before dispensing. If the labeler code of the
manufacturer of any given drug does not appear on the list, the
drug is not covered by the IHCP and providers are not entitled to
reimbursement for such products.