Drug Manufacturers Leaving the Medicaid Drug Rebate Program

Drug Manufacturer and Labeler

Drug Name

Drug NDC

BAUSCH & LOMB INC.
57782

CROMOLYN SOD SPR 5.2/ACT

57782039726

BAUSCH HEALTH US

MYSOLINE TAB 250MG

66490069110

LLC

MYSOLINE TAB 50MG

66490069010

00187

DIASTAT PED GEL 2.5M GEL

66490065020

66490

SOLODYN TAB 55MG

99207046530

99207

SOLODYN TAB 65MG

99207046330

25010

SOLODYN TAB 80MG

99207046630

16781

SOLODYN TAB 105MG

99207046730

13548

SOLODYN TAB 115MG

99207046430

VANOS CRE 0.1%

99207052510

ZYCLARA PUMP CRE 3.75%

99207027175

LODOSYN TAB 25MG

25010071115

CUPRIMINE CAP 250MG

25010070515

DEMSER CAP 250MG

25010030515

EDECRIN TAB 25MG

25010021515

CLINDAGEL GEL 1%

16781046275

SOD EDECRIN INJ 50MG

25010021027

ACANYA GEL 1.2-2.5%

13548013250

ATRALIN GEL 0.05%

13548007045

ZIANA GEL

99207030030

ZIANA GEL

99207030060

LOPROX SHA 1%

99207001010

LUZU CRE 1%

99207085060

Drug Manufacturer and Labeler

Drug Name

Drug NDC

BAUSCH HEALTH US

VANOS CRE 0.1%

99207052530

LLC

VANOS CRE 0.1%

99207052560

00187

LOCOID LOT 0.1%

16781039202

66490

LOCOID LOT 0.1%

16781039204

99207

LOCOID LIPO CRE 0.1%

16781038445

25010

ZYCLARA PUMP CRE 2.5%

99207027675

16781

ZYCLARA CRE 3.75%

99207027028

13548

ZOSTRIX-HP MIS 0.075%

99207060704

ATOPICLAIR CRE

99207012010

ANCOBON CAP 500MG

00187355510

ANCOBON CAP 250MG

00187355410

VIRAZOLE INH 6GM

00187000714

AMMONUL INJ 10%

00187001050

APLENZIN TAB 522MG

00187581230

APLENZIN TAB 522MG

00187581207

APLENZIN TAB 348MG

00187581130

APLENZIN TAB 348MG

00187581107

APLENZIN TAB 174MG

00187581030

APLENZIN TAB 174MG

00187581007

VISUDYNE INJ 15MG

00187560015

TARGRETIN CAP 75MG

00187552675

TARGRETIN GEL 1%

00187552560

CORN HUSKERS LOT

00187551007

PURPOSE GENT LIQ WASH

00187550606

CALADRYL CLR LOT 1-0.1%

00187546606

CALADRYL LOT 1-8%

00187546506

JUBLIA SOL 10%

00187540008

JUBLIA SOL 10%

00187540004

MAGONATE LIQ 1000/5ML

00187526701

OCEAN KIDS SPR 0.65%

00187526501

OCEAN COMPL AER SINUS

00187526301

OCEAN ULTRA GEL MOISTRIZ

00187526201

OCEAN COMPL AER SINUS

00187526011

OCEAN NASAL SPR 0.65%

00187526003

OCEAN NASAL SPR 0.65%

00187526002

OCEAN NASAL SPR 0.65%

00187526001

BENZAMYCIN GEL 5-3%

00187520546

NORITATE CRE 1%

00187520260

KLARON LOT 10%

00187519804

RETIN-A GEL 0.01%

00187517245

RETIN-A GEL 0.01%

00187517215

Drug Manufacturer and Labeler

Drug Name

Drug NDC

BAUSCH HEALTH US

RETIN-A GEL 0.025%

00187517045

LLC

AMYTAL SOD INJ 500MG

00187430305

00187

RETIN-A GEL 0.025%

00187517015

66490

RETIN-A CRE 0.1%

00187516445

99207

RETIN-A CRE 0.1%

00187516420

25010

RETIN-A CRE 0.05%

00187516245

16781

MIGRANAL SPR 4MG/ML

00187024503

13548

DIASTAT ACDL GEL 5-10MG

00187065820

DIASTAT ACDL GEL 12.5-20

00187065920

RETIN-A CRE 0.05%

00187516220

RETIN-A CRE 0.025%

00187516045

RETIN-A CRE 0.025%

00187516020

RENOVA CRE 0.02%

00187515060

RENOVA PUMP CRE 0.02%

00187515044

RENOVA CRE 0.02%

00187515040

RENOVA CRE 0.02%

00187515020

RETIN-A MICR GEL 0.08%PMP

00187514850

RETIN-A MICR GEL 0.06%PMP

00187514650

RETIN-A MICR GEL 0.04%PMP

00187514450

RETIN-A MICR GEL 0.04%

00187514445

RETIN-A MICR GEL 0.04%

00187514420

RETIN-A MICR GEL 0.1%PUMP

00187514050

TIMOPTIC OCU SOL 0.25% OP

00187149825

RETIN-A MICR GEL 0.1%

00187514045

RETIN-A MICR GEL 0.1%

00187514020

BIAFINE EMU

00187511090

BIAFINE EMU

00187511045

XERESE CRE 5-1%

00187510401

ELIDEL CRE 1%

00187510203

ELIDEL CRE 1%

00187510102

ELIDEL CRE 1%

00187510001

PEPCID TAB 40MG

00187444030

PEPCID TAB 40MG

00187444010

BENZEFOAM AER 5.3%

00187019410

PEPCID TAB 20MG

00187442030

PEPCID TAB 20MG

00187442010

LIBRAX CAP 5-2.5MG

00187410010

ONEXTON GEL 1.2-3.75

00187305050

ONEXTON GEL 1.2-3.75

00187305035

MESTINON TAB TIMESPAN

00187301330

Drug Manufacturer and Labeler

Drug Name

Drug NDC

BAUSCH HEALTH US

MESTINON SOL 60MG/5ML

00187301220

LLC

MESTINON TAB 60MG

00187301030

00187

TIAZAC CAP 420MG/24

00187261790

66490

TIAZAC CAP 420MG/24

00187261730

99207

TIAZAC CAP 360MG/24

00187261690

25010

TIAZAC CAP 360MG/24

00187261630

16781

TIAZAC CAP 300MG/24

00187261590

13548

TIAZAC CAP 300MG/24

00187261530

TIAZAC CAP 240MG/24

00187261490

TIAZAC CAP 240MG/24

00187261430

TIAZAC CAP 180MG/24

00187261390

TIAZAC CAP 180MG/24

00187261330

TIAZAC CAP 120MG/24

00187261290

TIAZAC CAP 120MG/24

00187261230

SYPRINE CAP 250MG

00187212010

ARAZLO LOT 0.045%

00187209845

CARDIZEM LA TAB 420MG/24

00187205090

CARDIZEM LA TAB 420MG/24

00187205030

CARDIZEM LA TAB 360MG

00187204990

CARDIZEM LA TAB 360MG

00187204930

CARDIZEM LA TAB 300MG/24

00187204890

CARDIZEM LA TAB 300MG/24

00187204830

CARDIZEM LA TAB 240MG

00187204790

CARDIZEM LA TAB 240MG

00187204730

CARDIZEM LA TAB 180MG

00187204690

CARDIZEM LA TAB 180MG

00187204630

CARDIZEM LA TAB 120MG

00187204590

CARDIZEM LA TAB 120MG

00187204530

WIBI LOT

00187168016

VELVACHOLCRE

00187167814

THERASEAL LOT 1%

00187166006

NITEBITE BAR PBUTTER

00187153727

NITEBITE BAR PBUTTER

00187153185

NITEBITE BAR CHOCFUDG

00187152720

NITEBITE BAR CHOCFUDG

00187152188

NUTRAPLUS LOT 10%

00187147516

NUTRAPLUS LOT 10%

00187147408

ERTACZO CRE 2%

00187511560

NUTRAPLUS CRE 10%

00187147116

NUTRAPLUS CRE 10%

00187147003

Drug Manufacturer and Labeler

Drug Name

Drug NDC

BAUSCH HEALTH US

NUTRADERM LOT

00187145816

LLC

NUTRADERM LOT ADVANCED

00187145216

00187

IONIL-T SHA 1%

00187141616

66490

CARAC CRE 0.5%

00187520030

99207

EFUDEX CRE 5%

00187320447

25010

ZOVIRAX CRE 5%

00187099445

16781

ZOVIRAX OIN 5%

00187099395

13548

TASMAR TAB 100MG

00187093801

CARDIZEM CD CAP 360MG/24

00187079942

CARDIZEM CD CAP 300MG/24

00187079842

CARDIZEM CD CAP 300MG/24

00187079830

CARDIZEM CD CAP 240MG/24

00187079742

CARDIZEM CD CAP 240MG/24

00187079730

CARDIZEM CD CAP 180MG/24

00187079642

CARDIZEM CD CAP 180MG/24

00187079630

CARDIZEM CD CAP 120MG/24

00187079542

CARDIZEM CD CAP 120MG/24

00187079530

CARDIZEM TAB 120MG

00187079247

CARDIZEM TAB 60MG

00187077247

CARDIZEM TAB 30MG

00187077147

WELLBUTRIN TAB XL 300MG

00187073130

WELLBUTRIN TAB XL 300MG

00187073107

WELLBUTRIN TAB XL 150MG

00187073090

WELLBUTRIN TAB XL 150MG

00187073030

WELLBUTRIN TAB XL 150MG

00187073007

DUOBRII LOT

00187065301

RV PAQUE CRE

00187053935

RV PAQUE CRE

00187053934

ZELAPAR TAB 1.25MG

00187045302

VITADYE LOT 5%

00187041335

VITADYE LOT 5%

00187041302

KINERASE CRE 0.125%

00187040944

KINERASE LOT 0.1%

00187040355

KINERASE CRE 0.1%

00187040148

ISORDIL TAB 40MG

00187019201

ISORDIL TAB 5MG

00187015201

VASERETIC TAB 10-25MG

00187014601

VASOTEC TAB 20MG

00187014390

VASOTEC TAB 20MG

00187014330

VASOTEC TAB 20MG

00187014310

VASOTEC TAB 10MG

00187014290

Drug Manufacturer and Labeler

Drug Name

Drug NDC

BAUSCH HEALTH US

VASOTEC TAB 10MG

00187014230

LLC

VASOTEC TAB 10MG

00187014210

00187

VASOTEC TAB 5MG

00187014190

66490

VASOTEC TAB 5MG

00187014130

99207

VASOTEC TAB 2.5MG

00187014090

25010

VASOTEC TAB 2.5MG

00187014030

16781

ATIVAN TAB 2MG

00187006501

13548

ATIVAN TAB 1MG

00187006410

HYLATOPIC CRE PLUS

00187001345

ATIVAN TAB 1MG

00187006401

ATIVAN TAB 0.5MG

00187006301

CABTREO GEL

00187000625

ALTRENO LOT 0.05%

00187000545

ALTRENO LOT 0.05%

00187000520

SILIQ INJ 210/1.5

00187000402

SILIQ INJ 210/1.5

00187000400

BRYHALI LOT 0.01%

00187000260

BRYHALI LOT 0.01%

00187000201

OCEANSIDE

RIBAVIRIN INH 6GM

68682001901

PHARMACEUTICALS

RIBAVIRIN INH 6GM

68682001906

68682

BEXAROTENE CAP 75MG

68682000310

BUDESONIDE TAB ER 9MG

68682030930

ERY/BENZOYL GEL 3-5%

68682090146

ENALAPRIL TAB 20MG

68682071310

METFORMN MOD TAB 500MG ER

68682002150

METFORMN MOD TAB 1000 ER

68682001890

SOD BENZATE/ SOL PHEN 10%

68682000150

ENALAPRIL TAB 20MG

68682071301

ENALAPRIL TAB 10MG

68682071210

ENALAPRIL TAB 10MG

68682071201

ENALAPRIL TAB 5MG

68682071110

ENALAPRIL TAB 5MG

68682071101

ENALAPRIL TAB 2.5MG

68682071010

DILTIAZEM TAB 30MG

68682000650

ENALAPRIL TAB 2.5MG

68682071001

TRETINOIN GEL 0.08%

68682051595

DILTIAZEM TAB 60MG

68682000750

TRETINOIN GEL 0.04%PMP

68682051495

DILTIAZEM TAB 90MG

68682000850

TRETINOIN GEL 0.04%

68682051494

Drug Manufacturer and Labeler

Drug Name

Drug NDC

OCEANSIDE

TRETINOIN GEL 0.04%

68682051492

PHARMACEUTICALS

TRETINOIN GEL 0.1%PUMP

68682051385

68682

TRETINOIN GEL 0.1%

68682051384

DILTIAZEM TAB 120MG ER

68682070430

DILTIAZEM TAB 120MG ER

68682070490

TRETINOIN GEL 0.1%

68682051382

BRINZOLAMIDE SUS 1%

68682046415

DILTIAZEM ER TAB 180MG

68682070530

DILTIAZEM ER TAB 180MG

68682070590

BRINZOLAMIDE SUS 1%

68682046410

TETRABENAZIN TAB 12.5MG

68682042112

DILTIAZEM ER TAB 240MG

68682070630

DILTIAZEM ER TAB 240MG

68682070690

DILTIAZEM CAP 360MG ER

68682037190

DIHYDROERGOT SPR 4MG/ML

68682035710

DILTIAZEM ER TAB 300MG

68682070730

DILTIAZEM ER TAB 300MG

68682070790

METYROSINE CAP 250MG

68682031001

BUTALB/ACETA TAB 50-300MG

68682030601

DILTIAZEM ER TAB 360MG

68682070830

DILTIAZEM ER TAB 360MG

68682070890

AZATHIOPRINE TAB 100MG

68682024101

AZATHIOPRINE TAB 75MG

68682023101

DILTIAZEM ER TAB 420MG

68682070930

DILTIAZEM ER TAB 420MG

68682070990

PEG/NASUL/C/ SOL NACL/POT

68682020175

ISOSORB DIN TAB 5MG

68682019301

DILTIAZEM CAP 120MG/24

68682036790

ISOSORB DIN TAB 40MG

68682019201

CLINDAMY/BEN GEL 1.2-3.75

68682013350

DILTIAZEM CAP 180MG/24

68682036890

PIMECROLIMUS CRE 1%

68682011203

PIMECROLIMUS CRE 1%

68682011102

DILTIAZEM CAP 240MG/24

68682036990

PIMECROLIMUS CRE 1%

68682011001

NIFEDIPINE TAB 60MG ER

68682010930

DILTIAZEM CAP 300MG ER

68682037090

NIFEDIPINE TAB 60MG ER

68682010910

NIFEDIPINE TAB 30MG ER

68682010830

NIFEDIPINE TAB 30MG ER

68682010810

NIFEDIPINE TAB 90MG ER

68682010710

Drug Manufacturer and Labeler

Drug Name

Drug NDC

OCEANSIDE

NIFEDIPINE TAB 60MG ER

68682010630

PHARMACEUTICALS

DILTIAZEM CAP 420MG/24

68682037290

68682

NIFEDIPINE TAB 60MG ER

68682010610

NIFEDIPINE TAB 30MG ER

68682010530

DILTIAZEM CAP 120MG ER

68682099398

NIFEDIPINE TAB 30MG ER

68682010510

DICLOFENAC TAB 100MG ER

68682010301

DILTIAZEM CAP 180MG ER

68682099498

PENICILLAMIN CAP 250MG

68682002010

ETHACRYNIC TAB ACD 25MG

68682001110

DILTIAZEM CAP 240MG ER

68682099798

SULFACETAMID LOT 10%

68682001004

DILTIAZEM TAB 120MG

68682000910

DILTIAZEM CAP 300MG ER

68682099898

DILTIAZEM TAB 90MG

68682000810

DILTIAZEM CAP 360MG CD

68682052101

DILTIAZEM TAB 60MG

68682000710

DILTIAZEM TAB 30MG

68682000610

METHAZOLAMID TAB 25MG

68682002210

FENOFIBRATE TAB 40MG

68682049090

FENOFIBRATE TAB 120MG

68682049590

OMEPRA/BICAR CAP 40-1100

68682010430

OMEPRA/BICAR POW 20-1680

68682099030

OMEPRA/BICAR POW 40-1680

68682099130

MESALAMINE CAP 0.375GM

68682011320

METRONIDAZOL GEL 0.75%VAG

68682045570

TETRABENAZIN TAB 25MG

68682042225

DIAZEPAM GEL 2.5MG

68682065020

DIAZEPAM GEL 10MG

68682065220

DIAZEPAM GEL 20MG

68682065520

TOLCAPONE TAB 100MG

68682093890

CARBIDOPA TAB 25MG

68682020025

PYRIDOSTIGM TAB 60MG

68682030210

PYRIDOSTIGMI TAB ER 180MG

68682030130

PYRIDOSTIGMI SOL 60MG/5ML

68682030705

TIMOLOL MAL SOL 0.5% OP

68682081305

TIMOLOL MALE SOL 0.5%

68682004525

TIMOLOL MALE SOL 0.5%

68682004550

LOTEPREDNOL SUS 0.5%

68682029905

LOTEPREDNOL SUS 0.5%

68682029910

LOTEPREDNOL SUS 0.5%

68682029915

Drug Manufacturer and Labeler

Drug Name

Drug NDC

OCEANSIDE

TETRACAINE SOL 0.5% OP

68682092005

PHARMACEUTICALS

TETRACAINE SOL 0.5% OP

68682092064

68682

FLUORE/BENOX SOL 0.3-0.4%

68682073205

BUDESONIDE AER 2MG/ACT

68682065802

BUDESONIDE AER 2MG/ACT

68682065803

TRETINOIN GEL 0.05%

68682080045

CLINDAMYCIN GEL 1%

68682046275

ERY/BENZOYL GEL 3-5%

68682090023

CLINDAMY/BEN GEL 1.2-2.5%

68682013250

CLINDAMYCIN GEL TRETINOI

68682030030

CLINDAMYCIN GEL TRETINOI

68682030060

LULICONAZOLE CRE 1%

68682085060

BEXAROTENE GEL 1%

68682000260

HYDROCORTISO LOT 0.1%

68682039202

HYDROCORTISO LOT 0.1%

68682039204

HC BUTYRATE OIN 0.1%

68682027115

HC BUTYRATE OIN 0.1%

68682027145

HC BUTYRATE CRE 0.1%

68682038445

HC BUTYRATE CRE 0.1%

68682038460

IMIQUIMOD CRE 3.75%PMP

68682027275

TRIENTINE CAP 250MG

68682021210

PEDINOL PHARMACAL

LACTINOL HX CRE VANILLA

00884881204

00884

SLEEP-N-HEEL KIT

00884831103

EXFOLIX FOOT BAR SOAP

00884811104

SLEEP-N-HEEL MIS SLEEVES

00884801104

SLEEP-N-HEEL MIS SLEEVES

00884801102

NAIL SCRUB LIQ W/BRUSH

00884489102

PEDI-PRE SPR TAPE

00884169311

FUNGOID TINC SOL 2%

00884029301

BREEZEE MIST AER FOOT PWD

00884065904

UREACIN-20 CRE 20%

00884044904

UREACIN-10 LOT 10%

00884324908

PHENOL EZ MIS

00884629730

SALIX

XIFAXAN TAB 550MG

65649030302

PHARMACEUTICALS

XIFAXAN TAB 550MG

65649030303

INC.

UCERIS AER 2MG/ACT

65649065103

65649

UCERIS AER 2MG/ACT

65649065102

RELISTOR INJ 12/0.6ML

65649055107

RELISTOR INJ 12/0.6ML

65649055103

RELISTOR INJ 12/0.6ML

65649055102

Drug Manufacturer and Labeler

Drug Name

Drug NDC

SALIX

PROCTOCORT SUP 30MG

65649051112

PHARMACEUTICALS

PROCTOCORT CRE 1%

65649050130

INC.

ANUSOL-HC SUP 25MG

65649041124

65649

ANUSOL-HC SUP 25MG

65649041112

ANUSOL-HC CRE 2.5%

65649040130

PLENVU SOL

65649040001

DIURIL SUS 250/5ML

65649031112

XIFAXAN TAB 200MG

65649030103

AZASAN TAB 100MG

65649024141

AZASAN TAB 75 MG

65649023141

MOVIPREP SOL

65649020176

MOVIPREP SOL

65649020175

RELISTOR TAB 150MG

65649015090

ENVIVE CAP 115MG

65649010430

APRISO CAP 0.375GM

65649010302

COLAZAL CAP 750MG

65649010102

PLENVU SOL

65649040002

TRULANCE TAB 3MG

65649000303

TRULANCE TAB 3MG

65649000330

RELISTOR INJ 8/0.4ML

65649055204

SANTARUS, INC

GLUMETZA TAB 500MG

68012000450

68012

GLUMETZA TAB 1000MG

68012000316

CYCLOSET TAB 0.8MG

68012025820

UCERIS TAB 9MG

68012030930

UCERIS TAB 9MG

68012030901

FENOGLIDE TAB 40MG

68012049090

FENOGLIDE TAB 120MG

68012049590

ZEGERID CAP 20-1100

68012010230

ZEGERID CAP 40-1100

68012010430

ZEGERID POW 20-1680

68012005230

ZEGERID POW 40-1680

68012005401

ZEGERID POW 40-1680

68012005430