Navigating the New York State Medicaid Drug Rebate Program 

Established under the Omnibus Budget Reconciliation Act of 1990 (OBRA ’90), the Medicaid Drug Rebate Program (MDRP) mandates drug manufacturers to engage in agreements with the Centers for Medicare and Medicaid Services (CMS) to provide rebates for drugs covered by Medicaid. However, reimbursement for practitioner-administered drugs is contingent upon the drug’s qualification for rebate by 42 USC 1396r-8. 

Providers operating within Fidelis Care Medicaid and HARP plans are advised to utilize the following resources to ascertain whether a practitioner-administered drug qualifies for reimbursement: