Manufacturer Termination From the Medicaid Drug Rebate Program

Date: 09/18/25

Effective October 1, 2025, the following manufacturers will be terminated from the Medicaid Drug Rebate Program (MDRP) and will no longer be covered: 

Labeler Code	Manufacturer
99207	BAUSCH HEALTH US, LLC
68682	OCEANSIDE PHARMACEUTICALS
68012	SANTARUS, INC.
66530	SPEAR DERMATOLOGY PRODUCTS, INC.
66490	BAUSCH HEALTH US LLC
65649	SALIX PHARMACEUTICALS, INC.
57782	BAUSCH & LOMB INC.
25010	BAUSCH HEALTH US, LLC
16781	BAUSCH HEALTH US, LLC
13548	BAUSCH HEALTH US, LLC
00884	PEDINOL PHARMACAL INC.
00187	BAUSCH HEALTH US, LLC
48102	FERA PHARMACEUTICALS, LLC
00095	BAUSCH HEALTH US, LLC
10337	PHARMADERM (DIVISION OF FOUGERA PHARMA)
10922	INTENDIS, INC.
37205	CARDINAL HEALTH
41616	SUN PHARMA GLOBAL, INC.
43199	COUNTY LINE PHARMACEUTICALS, LLC
48818	ACROTECH BIOPHARMA LLC
72730	QED THERAPEUTICS, INC.
72912	ADLON THERAPEUTICS L.P.
29033	NOSTRUM LABORATORIES
80644	ZEALAND PHARMA AS

Please note, the labeler code is the first five digits of the National Drug Code (NDC). 

Effective October 1, 2025, the following medications that are made by the above manufactures are no longer going to be covered by the MDRP:

ACANYA GEL PUMP ACETAZOLAMIDE ER 500 MG CAP APRISO ER 0.375 GRAM CAPSULE ARAZLO 0.045% LOTION AZATHIOPRINE 100 MG TABLET BRINZOLAMIDE 1% EYE DROPS CABTREO 1.2%-0.15%-3.15% GEL CARBAMAZEPINE ER 100 MG CAP CARBAMAZEPINE ER 200 MG CAP CARBAMAZEPINE ER 300 MG CAP CLINDAMYCIN PHOSPHATE 1% GEL DIAZEPAM 10 MG RECTAL GEL (2PK) DIAZEPAM 2.5 MG RECTAL GEL (2PK) DIAZEPAM 20 MG RECTAL GEL (2PK) DICLOFENAC SOD ER 100 MG TAB

DILTIAZEM 120 MG TABLET DILTIAZEM 24H ER(CD) 120 MG CP DILTIAZEM 24H ER(CD) 180 MG CP DILTIAZEM 24H ER(CD) 240 MG CP DILTIAZEM 24H ER(LA) 420 MG TB DILTIAZEM 24HR ER 120 MG CAP DILTIAZEM 24HR ER 180 MG CAP DILTIAZEM 24HR ER 240 MG CAP DILTIAZEM 24HR ER 300 MG CAP DILTIAZEM 24HR ER 360 MG CAP DILTIAZEM 60 MG TABLET DILTIAZEM 90 MG TABLET DIURIL 250 MG/5 ML ORAL SUSP EFUDEX 5% CREAM ELIDEL 1% CREAM ERYTHROMYCIN-BENZOYL GEL ETHACRYNIC ACID 25 MG TABLET

JUBLIA 10% TOPICAL SOLUTION MESTINON 60 MG/5 ML SOLUTION NIFEDIPINE ER 30 MG TABLET NIFEDIPINE ER 60 MG TABLET NIFEDIPINE ER 90 MG TABLET PIMECROLIMUS 1% CREAM RETIN-A 0.01% GEL RETIN-A 0.025% CREAM RETIN-A 0.025% GEL RETIN-A 0.05% CREAM RETIN-A 0.1% CREAM SUCRALFATE 1 GM TABLET THEOPHYLLINE ER 400 MG TABLET THEOPHYLLINE ER 600 MG TABLET TRETINOIN 0.05% GEL TRULANCE 3 MG TABLET VITAMIN D3 1,000 UNIT SOFTGEL WELLBUTRIN XL 150 MG TABLET WELLBUTRIN XL 300 MG TABLET  XIFAXAN 550 MG TABLET

For additional information regarding the MDRP changes please email our pharmacyteam:
ITC-Pharmacy@IowaTotalCare.com.

For questions or concerns, contact your provider engagement account manager in your area or call Provider Services at 1-833-404-1061, Monday – Friday 7:30 a.m. to 6 p.m. CT.

Thank you for your partnership in serving Iowa Total Care members.