Bulletin

Michigan Department of Community Health

Bulletin Number: MSA 07-33

Distribution: Practitioners (Physicians, Advanced Practice Nurses, Medical Clinics, Oral Surgeons, Podiatrists, FQHCs/RHCs/THCs), Medical Suppliers, Local Health Departments, Family Planning Clinics, Hospitals, Prepaid Inpatient Health Plans, Community Mental Health Services Programs and Substance Abuse Coordinating Agencies

Issued: June 15, 2007

Subject: Reporting National Drug Codes for Physician Administered Drugs on Electronic and Paper Formats

Effective: July 15, 2007

Programs Affected: Medicaid

The purpose of this bulletin is to inform providers of the requirement to report the National Drug Code (NDC) and its corresponding information in addition to the procedure code billed for a physician administered drug on the electronic professional and institutional claim formats as well as the CMS 1500. Information on reporting the NDC on the UB-04 is forthcoming. This requirement is mandated by the Deficit Reduction Act of 2005 which requires Medicaid to collect rebates for physician administered drugs. Also, information concerning the reporting of the National Provider Identifier (NPI) is included in this bulletin.

Coverage of a physician administered drug is limited to a drug product from a manufacturer who has a signed rebate agreement with the Centers for Medicare & Medicaid Services (CMS). A current listing of the manufacturers that have signed rebate agreements with CMS is attached and can also be found on the CMS website at http://www.cms.hhs.gov/MedicaidDrugRebateProgram/10_DrugComContactInfo.asp. Providers are required to view the above website for any changes. Michigan Department of Community Health (MDCH) will not continue to provide a current list.

The NDC is a unique eleven digit (11 digit) identifier assigned to a drug product by the labeler/manufacturer under Federal Drug Administration (FDA) regulations. Claims submitted with invalid or missing NDC information or NDC's by a drug manufacturer who does not have a signed rebate agreement with CMS will reject with Edit 995 (Missing or Invalid National Drug Code (NDC) or Product Distributed by an Unapproved Manufacturer).

The NDC information must be reported on Medicare crossover claims.

ELECTRONIC BILLING INSTRUCTIONS

Effective for dates of service on or after July 15, 2007, providers must report the 11 digit NDC and its corresponding information in addition to the procedure code in the LIN Segment of LOOP ID 2410 to specify the physician administered drug that is part of the service described in SV1 for the professional and institutional 837 4010A1 claim formats. Providers must also report the quantity and unit of measure of the NDC as outlined below in Table 1a and Table 1b. MSA 07-33 Page 2 of 3

TABLE 1a

Reporting NDC Information in 837 Professional & Institutional Formats

LIN Segment – Drug Identification e.g., LIN**N4*01234567891 LIN02 N4 N4 Qualifier identifies NDC being billed

Actual NDC Report NDC in the 11 digit format (5-4-2). LIN03 Do not use hyphens or spaces. e.g., 01234567891

TABLE 1b

Reporting NDC Information in 837 Professional & Institutional Formats

CTP Segment – Drug Segment e.g., CTP***2.50*2*UN e.g., 2.50 CTP03 Unit Price Do not report the dollar sign. CTP04 Dispensing Quantity e.g., 2 Values are: F2 = International Unit CTP05 Unit of Measure Value GR = Gram ML = Milliliter UN = Unit

Reporting Multiple NDCs (Including Compound Drugs)

To bill a procedure code with multiple NDCs:

ƒ Report the first NDC and its information as instructed above; and

ƒ Report the additional NDC(s) and its information in the NTE Segment of LOOP ID 2300.

PAPER BILLING INSTRUCTIONS

Effective for dates of service on or after July 15, 2007, providers utilizing the CMS 1500 should refer to the following resources for instruction on reporting NDCs:

ƒ National Uniform Claim Committee (NUCC) 1500 Health Insurance Claim Form Reference Manual for Version 08/05,

ƒ Bulletin MSA 07-09, and

ƒ July 2007 version of the Billing & Reimbursement for Professionals Chapter in the Michigan Medicaid Provider Manual (www.michigan.gov/mdch >> Providers >> Information for Medicaid Providers >> Medicaid Provider Manual).

Note: Providers can report decimals if they are part of the NDC information for quantity and price.

Information for reporting NDCs on the UB-04 is forthcoming. Examples in reporting the NDC information of a physician administered drug on a CMS 1500 are attached.

MSA 07-33 Page 3 of 3

Reporting Multiple NDCs (Including Compound Drugs)

To bill a procedure code with multiple NDCs:

ƒ Report the first NDC and its information on the CMS 1500 within the shaded supplemental service line as outlined in the NUCC instructions; and

ƒ Report the additional NDCs and its information in a claim attachment. Report “see attachment” in Item 19 on the CMS 1500 to indicate that additional NDC information is being billed.

NDC FORMAT FOR BILLING

The 11 digit format is 5-4-2 (XXXXXXXXXXX). The first segment identifies the labeler/manufacturer. The second segment identifies the product, product’s strength, dosage form, and formulation. The third segment identifies the package of the drug. Table 2 (below) provides examples in billing the 5-4-2 format.

TABLE 2

Examples of 5-4-2 NDC Format

NDC 5-4-2 Format Explanation 1234567891 01234-5678-91 Add a zero if the first segment has only four numbers. 1234567891 12345-0678-91 Add a zero if the second segment has only three numbers. 1234567891 12345-6789-01 Add a zero if the third segment has only one number.

REPORTING NATIONAL PROVIDER IDENTIFIER

Effective October 1, 2007, prescribers are reminded that they must provide their individual NPIs to pharmacies in order for all prescriptions including refills to be dispensed to beneficiaries.

Manual Maintenance

Retain this bulletin until the information has been incorporated into the Michigan Medicaid Provider Manual.

Questions

Any questions regarding this bulletin should be directed to Provider Inquiry, Department of Community Health, P.O. Box 30731, Lansing, Michigan 48909-8231, or e-mail at [email protected]. When you submit an e-mail, be sure to include your name, affiliation, and phone number so you may be contacted if necessary. Providers may phone toll-free 1-800-292-2550.

Approved

Paul Reinhart, Director Medical Services Administration MICHIGAN DEPARTMENT OF COMMUNITY HEALTH EXAMPLES FOR BILLING THE NDC INFORMATION FOR A PHYSICIAN ADMINISTERED DRUG

Example 1: The practitioner administered 1 gram (4 vials) of abatacept intravenously to 150 kg beneficiary for 30 minutes.

24. A. DATE(S) OF SERVICE B. C. D. PROCEDURES, SERVICES, OR SUPPLIES E. F. G. H. I. J. (Explain Unusual Circumstances) DAYS OR EPSDT PLACE OF DIAGNOSIS ID. RENDERING FROM To SERVICE EMG UNITS Family MM DD YY MM DD YY CPT/HCPCS MODIFIER POINTER $ CHARGES Plan QUAL. PROVIDER I.D. # N400003218710 ABATACEPT INTRAVENOUS GM 200 N

04 02 07 04 02 07 11 J0129 1800 00 100 N NPI 1234567891

Example 2: The practitioner administered 0.5 mL of Tdap vaccine intramuscularly to a 12 years old beneficiary.

24. A. DATE(S) OF SERVICE B. C. D. PROCEDURES, SERVICES, OR SUPPLIES E. F. G. H. I. J. PLACE OF (Explain Unusual Circumstances) DAYS OR EPSDT ID. FROM To EMG DIAGNOSIS UNITS Family RENDERING SERVICE MM DD YY MM DD YY CPT/HCPCS MODIFIER POINTER $ CHARGES Plan QUAL. PROVIDER I.D. # N458160084211 TDAP VACCINE INTRAMUSCULAR ML1 Y

04 02 07 04 02 07 11 90715 30 00 1 Y NPI 1234567891

Example 3: The practitioner administered 10 mg of olanzapine.

24. A. DATE(S) OF SERVICE B. C. D. PROCEDURES, SERVICES, OR SUPPLIES E. F. G. H. I. J. (Explain Unusual Circumstances) DAYS OR EPSDT PLACE OF DIAGNOSIS ID. RENDERING FROM To SERVICE EMG UNITS Family MM DD YY MM DD YY CPT/HCPCS MODIFIER POINTER $ CHARGES Plan QUAL. PROVIDER I.D. # N400002759701 OLANZAPINE INTRAMUSCULAR UN1 N

04 02 07 04 02 07 11 S0166 25 00 4 N NPI 1234567891

Example 4: The practitioner administered 1500 International Units (IU) of Rho(D) immune globulin intravenously.

24. A. DATE(S) OF SERVICE B. C. D. PROCEDURES, SERVICES, OR SUPPLIES E. F. G. H. I. J. (Explain Unusual Circumstances) DAYS OR EPSDT PLACE OF DIAGNOSIS ID. RENDERING FROM To SERVICE EMG UNITS Family MM DD YY MM DD YY CPT/HCPCS MODIFIER POINTER $ CHARGES Plan QUAL. PROVIDER I.D. # N400944295004 RHOD IMMUNE GLOBULIN INTRAVENOUS F215 N

04 02 07 04 02 07 11 J2792 210 00 15 N NPI 1234567891

Example 5: The practitioner administered 150 ml of low osmolar contrast material, 250 -299 mg/ml iodine concentration intravenously.

24. A. DATE(S) OF SERVICE B. C. D. PROCEDURES, SERVICES, OR SUPPLIES E. F. G. H. I. J. (Explain Unusual Circumstances) DAYS OR EPSDT PLACE OF DIAGNOSIS ID. RENDERING FROM To SERVICE EMG UNITS Family MM DD YY MM DD YY CPT/HCPCS MODIFIER POINTER $ CHARGES Plan QUAL. PROVIDER I.D. # N400407222206 LOCM INTRAVENOUS ML150 N

04 02 07 04 02 07 11 Q9948 45 00 150 N NPI 1234567891

Example 6: The practitioner administers 40 mg of esomeprazole sodium via intravenous infusion for 30 minutes.

24. A. DATE(S) OF SERVICE B. C. D. PROCEDURES, SERVICES, OR SUPPLIES E. F. G. H. I. J. (Explain Unusual Circumstances) DAYS OR EPSDT PLACE OF DIAGNOSIS ID. RENDERING FROM To SERVICE EMG UNITS Family MM DD YY MM DD YY CPT/HCPCS MODIFIER POINTER $ CHARGES Plan QUAL. PROVIDER I.D. # N400186604001 ESOMEPRAZOLE SODIUM INTRAVENOUS UN40 N

04 02 07 04 02 07 11 J3490 1 70 1 N NPI 1234567891

MSA 07-33 Attachment I 06/15/07 MICHIGAN DEPARTMENT OF COMMUNITY HEALTH Current Listing of Manufacturers that have Signed Rebate Agreements with CMS

(OSI) EYETECH ATHLON PHARMACEUTICALS, INC. 3M PHARMACEUTICALS ATLEY PHARMACEUTICALS INC A. AARONS, INC AURIGA PHARMACEUTICALS, LLC A. H. ROBINS AUROBINDO PHARMA LTD. AAI PHARMA AUROBINDO PHARMA USA, INC. AUXILIUM PHARMACEUTICALS, INC. ABRIKA PHARMACEUTICALS, LLLP AVANIR PHARMACEUTICALS , INC. AVENTIS PASTEUR INC. INC. AVENTIS PHARMACEUTICALS, INC. PHARMACEUTICALS U.S., INC. AXCAN SCANDIPHARM, INC. ADAMS LABORATORIES, INC. AXIOM PHARMACEUTICAL CORPORATION ADVANCE PHARMACEUTICALS, INC. AYERST LABORATORIES ADVANCED VISION RESEARCH AZUR PHARMA, INC. ADVANCIS PHARMACEUTICAL CORPORATION B. BRAUN MEDICAL INC. AERO PHARMACEUTICALS, INC. B. F. ASCHER AND COMPANY, INC. AFFORDABLE PHARMACEUTICALS, LLC BALLAY PHARMACEUTICALS AKORN INC BARR LABORATORIES INC AKYMA PHARMACEUTICALS LLC BARRIER THERAPEUTICS ALAVEN PHARMACEUTICAL, LLC BAUSCH & LOMB INC. LABORATORIES, INC. BAXTER HEALTHCARE CORPORATION BAYER CORPORATION PHARMACEUTICAL DIV. ALLAN PHARMACEUTICAL, L.L.C. BEACH PRODUCTS INC INC BEDFORD LABORATORIES ALLIANT PHARMACEUTICALS, INC. BERGEN BRUNSWIG DRUG COMPANY ALPHAGEN LABORATORIES, INC. BERLEX, INC. ALPHARMA BETA DERMACEUTICALS INC. ALPHARMA BRANDED PRODUCTS DIVISION, INC IDEC ALTAIRE PHARMACEUTICALS, INC BIOGLAN PHARMACEUTICALS CO. CORPORATION BIOMARIN PHARMACEUTICALS, INC. AMBI PHARMACEUTICALS, INC. BIOVAIL PHARMACEUTICALS INC. AMERICAN BIOSCIENCE, INC. BLAINE COMPANY AMERICAN HEALTH PACKAGING BLAIREX LABORATORIES, INC. AMERICAN PHARMACEUTICAL PARTNERS, INC. BLANSETT PHARMACAL CO., INC. AMERICAN RED CROSS BOCA PHARMACAL, INC. AMERICAN REGENT LABORATORIES, INC. BOEHRINGER INGELHEIM PHARMACEUTICALS AMERIDERM LABORATORIES, LTD BOUDREAUX'S BUTT PASTE AMERIFIT PHARMA, INC. BRAINTREE LABORATORIES INC., USA BRECKENRIDGE PHARMACEUTICAL, INC. AMGEN/IMMUNEX BRIGHTON PHARMACEUTICALS, INC. AMKAS LABORATORIES INC. BRISTOL-MYERS SQUIBB AND GILEAD SCIENCE , INC. BRISTOL-MYERS SQUIBB COMPANY ANIP ACQUISITION COMPANY BRISTOL-MYERS SQUIBB/ PARTNERSHIP APOTEX CORP. C B FLEET COMPANY INC APOTHECON, INC. CADISTA PHARMACEUTICALS INC. APOTHECON/INVAMED CANGENE CORPORATION AR SCIENTIFIC, INC. CAPELLON PHARMACEUTICALS, LTD. ARMSTRONG PHARMACEUTICALS CARACO PHARMACEUTICAL LABORATORIES LTD ASCENT PEDIATRICS, INC. CAROLINA MEDICAL PRODUCTS COMPANY ASTELLAS CAROLINA PHARMACEUTICALS, INC. ASTELLAS PHARMA US, INC. CARRINGTON LABORATORIES, INC. ASTRAZENECA LP CARWIN ASSOCIATES, INC. ASTRAZENECA LP CEBERT PHARMACEUTICALS, INC.

MSA 07-33 Page 1 of 5 Attachment II MICHIGAN DEPARTMENT OF COMMUNITY HEALTH Current Listing of Manufacturers that have Signed Rebate Agreements with CMS

CELGENE CORPORATION EMREX/ECONOMED PHARMACEUTICALS, INC. CELL THERAPEUTICS, INC. ENDO PHARMACEUTICALS, INC. PHARMACEUTICALS ENZON PHARMACEUTICALS, INC. CENTOCOR, INC. EON LABS, INC. CENTRIX PHARMACEUTICAL, INC. ESI LEDERLE INC. , INC. ESP PHARMA, INC. CHAIN DRUG MARKETING ASSOCIATION, INC. ESPRIT PHARMA, INC. CHEMRICH LABORATORIES INC. ETHEX CORPORATION CHIRON CORPORATION EVERETT LABORATORIES, INC. CIMA LABS EXCELLIUM PHARMACEUTICAL, INC. COATS ALOE INTERNATIONAL, INC. FALCON PHARMACEUTICALS LTD. COBALT LABORATORIES, INC. FAMILY PHARMACY - AMERISOURCE/BERGEN COLGATE ORAL PHARMACEUTICALS, INC. FARO PHARMACEUTICALS, INC. COLLAGENEX PHARMACEUTICALS FEI WOMEN'S HEALTH LLC COLOPLAST CORPORATION FERNDALE LABORATORIES INC. CONTRACT PHARMACAL CORP FERRING PHARMACEUTICALS, INC. COPLEY PHARMACEUTICAL, INC. FLEMING AND COMPANY COREPHARMA, LLC FLUORITAB CORPORATION CORIA LABORATORIES, LTD. FOCUS LABORATORIES, INC. CORIXA CORPORATION FOREST LABORATORIES, INC. CORNERSTONE BIOPHARMA, INC. FRESENIUS MEDICAL CARE NORTH AMERICA COTHERIX, INC. FSC LABORATORIES, INC. CRITICAL THERAPEUTICS (CRTX) G&W LABORATORIES, INC , INC. GALDERMA LABORATORIES, L.P. CUMBERLAND PHARMACEUTICALS, INC. GALLIPOT INCORPORATED CURA PHARMACEUTICAL CO., INC. GATE PHARMACEUTICALS CV THERAPEUTICS, INC. (CVT) GEISS, DESTIN & DUNN, INC. CYPRESS PHARMACEUTICAL, LLC GEMINI PHARMACEUTICALS, INC. DAIICHI SANKYO, INC. , INC. , LLC GENERAMED, INC. DARTMOUTH PHARMACEUTICALS, INC. GENETICS INSTITUTE, INC. DAVA PHARMACEUTICALS, INC. GENPHARM, L.P. DELTA PHARMACEUTICALS, INC. , INC. DEPOMED. INC. GENZYME CORPORATION DERMA SCIENCES INC. GILBERT LABORATORIES DERMARITE INDUSTRIES, LLC , INC. DESTON THERAPEUTICS, LLC GLADES PHARMACEUTICALS LLC DEY L.P. GLAXOSMITHKLINE DIGESTIVE CARE, INC. GLENMARK PHARMACEUTICALS, INC., USA DISTA PRODUCTS CO DIV OF ELI LILLY & CO GLOBAL PHARMACEUTICAL CORPORATION DOAK DERMATOLOGICS GM PHARMACEUTICALS, INC. DR. REDDY'S LABORATORIES, INC. GOLDLINE LABORATORIES, INC. DUPONT PHARMACEUTICALS GRACEWAY PHARMACEUTICALS, LLC DURA PHARMACEUTICALS INC GRIFOLS BIOLOGICALS, INC. E FOUGERA AND CO. GTX, INC. E.R. SQUIBB & SONS, INC. GUARDIAN LABS DIV UNITED-GUARDIAN INC ECR PHARMACEUTICALS H.D. SMITH WHOLESALE DRUG COMPANY EDWARDS PHARMACEUTICALS, INC. HARVEST PHARMACEUTICALS, INC. EISAI INC. HAWTHORN PHARMACEUTICALS ELAN PHARMACEUTICALS, INC./ATHENA NEURO HEALTH CARE PRODUCTS DIVISION-HEALTH CA ELAN PHARMACEUTICALS, INC./CARNRICK LAB HEALTHPOINT, LTD. HEMISPHERX BIOPHARMA, INC.

MSA 07-33 Page 2 of 5 Attachment II MICHIGAN DEPARTMENT OF COMMUNITY HEALTH Current Listing of Manufacturers that have Signed Rebate Agreements with CMS

HERCON LABORATORIES CORPORATION LIGAND PHARMACEUTICALS, INC. HERITAGE PHARMACEUTICALS, INC. LLORENS PHARMACEUTICALS INT'L DIVISION HILL DERMACEUTICALS, INC. LNK INTERNATIONAL, INC. HILLESTAD PHARMACEUTICALS LTC PRODUCTS INC HI-TECH PHARMACAL CO. INC. LUNSCO, INC HOFFMANN-LA ROCHE LUPIN PHARMACEUTICALS, INC.. HOPE PHARMACEUTICALS MAJOR PHARMACEUTICALS , INC. BRAND PHARMACEUTICALS, INC IDEC PHARMACEUTICALS - BIOGEN IDEC MALLINCKRODT INC. IDENIX PHARMACEUTICALS MARLOP PHARMACEUTICALS, INC. IMARX THERAPEUTICS, INC. MARNEL PHARMACEUTICAL, INC. IMCLONE SYSTEMS, INCORPORATED MARTEC USA, LLC INSMED, INC. MAYNE PHARMA (USA) INC. INSTITUTO GRIFOLS MCKESSON CORPORATION VALU-RITE INTEGRITY PHARMACEUTICAL CORPORATION MCKESSON PACKAGING SERVICE, A DIVISION INTENDIS, INC. MCNEIL CONSUMER HEALTHCARE INTERMUNE, INC. MCNEIL PHARMACEUTICALS INTERNATIONAL MEDICATION SYSTEMS LTD MCNEIL-PPC, INC. INTERPHARM, INC MCR-AMERICAN PHARMACEUTICALS, INC. INWOOD LABORATORIES INC MEAD JOHNSON AND COMPANY IOPHARM LABORATORIES, INC. MEDECOR PHARMA, LLC ISTA PHARMACEUTICALS MEDICINE SHOPPE INTERNATIONAL, INC. IVAX LABS INC. MEDICIS DERMATOLOGICS, INC. IVAX PHARMACEUTICALS, INC. MEDIMMUNE ONCOLOGY, INC. IVAX RESEARCH, INC. MEDIMMUNE, INC. JACOBUS PHARMACEUTICALS CO INC. MEDLINE INDUSTRIES, INC. JANSSEN PHARMACEUTICA PRODUCTS, L.P. MEDPOINTE PHARMACEUTICALS JAYMAC PHARMACEUTICALS, LLC MEDTRONIC INC , INC. MERCK & CO., INC. JDS PHARMACEUTICALS, LLC MERCK/SCHERING-PLOUGH JV JMI-DANIELS PHARMACEUTICALS, INC. MERZ PHARMACEUTICALS JOHNSON & JOHNSON MEDICAL MGI GP DBA MGI PHARMA JOHNSON AND JOHNSON MERCK CONSUMER PHAR MGI PHARMA, INC. JONES PHARMA, INCORPORATED MIDLAND HEALTHCARE, LLC JSJ PHARMACEUTICALS MIDLOTHIAN LABORATORIES KENWOOD THERAPEUTICS MIKART INC. , INC. MILLENNIUM PHARMACEUTICALS, INC. KIRKMAN LABORATORIES, INC. MISEMER PHARMACEUTICAL, INC. KNOLL PHARMACEUTICAL COMPANY MISSION PHARMACAL COMPANY KONSYL PHARMACEUTICALS, INC. MONARCH PHARMACEUTICALS, INC. KOS PHARMACEUTICALS, INC. MONTE SANO PHARMACEUTICALS, INC. KREMERS URBAN, INC. MORTON GROVE PHARMACEUTICALS, INC KVD PHARMA, INC. MPM MEDICAL, INC. KVK-TECH, INC. MUTUAL PHARMACEUTICAL COMPANY LANNETT COMPANY, INC. BERTEK PHARMACEUTICALS, INC. LARKEN LABORATORIES, INC. MYLAN PHARMACEUTICALS, INC. LASER PHARMACEUTICALS, LLC MYOGEN, INC. LEADER NABI BIOPHARMACEUTICALS LEDERLE LABORATORIES NEIL LABORATORIES, INC. LEDERLE PARENTERALS NEPHRON PHARMACEUTICALS CORPORATION LEDERLE PIPERACILLIN NEPHRO-TECH, INC. LEK PHARMACEUTICALS, INC. NITROMED, INC.

MSA 07-33 Page 3 of 5 Attachment II MICHIGAN DEPARTMENT OF COMMUNITY HEALTH Current Listing of Manufacturers that have Signed Rebate Agreements with CMS

NNODUM PHARMACEUTICAL CORPORATION PROCTER & GAMBLE PHARMACEUTICALS, INC. NOMAX, INC. PROETHIC PHARMACEUTICALS, INC. NOSTRUM LABORATORIES PROMETHEUS LABORATORIES, INC. NOVARTIS CONSUMER HEALTH, INC. PRO-PHARMA LLC NOVAVAX, INC. PROVIDENT PHARMACEUTICAL, INC. NOVAVAX, INC. (FORMERLY FIELDING) PURDUE FREDERICK COMPANY NOVO NORDISK, INC. , L.P. OCUSOFT INC. PURDUE PHARMCEUTICAL PRODUCTS, L.P. ODYSSEY PHARMACEUTICAL, INC. PURDUE PRODUCTS, L.P. OHM PHARMACEUTICALS, INC. QOL MEDICAL OMNII PRODUCTS PHARMACEUTICALS, INC. ONCOLOGY THERAPEUTICS NETWORK JOINT VEN QUESTCOR PHARMACEUTICALS, INC. ONSET THERAPEUTICS R.A. MCNEIL COMPANY OPTICS LABORATORY INC. RANBAXY LABORATORIES INCORPORATED ORGANON USA INC. RANBAXY PHARMACEUTICALS, INC. ORPHAN MEDICAL, INC. RARE DISEASE THERAPEUTICS, INC. ORTHO BIOTECH INC. RECKITT BENCKISER PHARMACEUTICALS, INC. CORPORATION RED RIVER PHARMA MANUFACTURING, LLC OSCIENT PHARMACEUTICALS CORPORATION RELIANT PHARMACEUTICALS, INC. OTN GENERICS, INC. RESPA PHARMACEUTICALS, INC. OTSUKA AMERICA RICHMOND PHARMACEUTICALS, INC. , INC. RISING PHARMACEUTICALS, INC. PACIFIC PHARMA RIVER'S EDGE PHARMACEUTICALS PACK PHARMACEUTICALS, L.L.C. ROMARK LABORATORIES, L.C. PADDOCK LABORATORIES, INC. ROSEMONT PHARMACEUTICALS, LTD. PAMLAB, LLC ROXANE LABORATORIES, INC. PAR PHARMACEUTICAL, INC RXELITE HOLDINGS, INC. D.B.A. RXELITE PARENTA PHARMACEUTICALS, INC. SAGE PHARMACEUTICALS, INC. PARKEDALE PHARMACEUTICALS, INC. , INC. PATRIOT PHARMACEUTICALS, LLC SANDOZ PBM PHARMACEUTICALS, INC. SANOFI-AVENTIS, US LLC PEDIAMED PHARMACEUTICALS, INC. SANOFI-SYNTHELABO INC. PEDINOL PHARMACAL INC SANTARUS, INC. PHARMACEUTICALS SANTEN INCORPORATED PERSON & COVEY, INC. SAVAGE LABORATORIES CONSUMER HEALTHCARE SAVIENT PHARMACEUTICALS, INC. PFIZER, INC. SCHERING CORPORATION PHARBEST PHARMACEUTICALS, INC. SCHERING HEALTHCARE PRODUCTS PHARMACEUTICAL ASSOCIATES, INC. SCHWARZ PHARMA LLC PHARMADERM SCIELE PHARMA, INC. PHARMASCIENCE LABORATORIES, INC. SCIOS, INC. PHARMELLE, LLC SDA LABORATORIES PHARMICS INC. SELECT BRAND DISTRIBUTORS PHARMION CORPORATION SENECA PHARMACEUTICALS, INC PLIVA, INC. SEPRACOR, INC. PLYMOUTH PHARMACEUTICALS, INC. SERONO, INC. POLY PHARMACEUTICAL CO., INC. SEVEN OAKS PHARMACEUTICAL CORP. SHERWOOD MEDICAL PRECISION DOSE, INC. SHIONOGI USA, INC. PRESUTTI LABORATORIES, INC. SHIRE US, INC. PRIME MARKETING LLC SICOR PHARMACEUTICALS, INC. PRIMUS PHARMACEUTICALS, INC. SIGMA-TAU PHARMACEUTICALS

MSA 07-33 Page 4 of 5 Attachment II MICHIGAN DEPARTMENT OF COMMUNITY HEALTH Current Listing of Manufacturers that have Signed Rebate Agreements with CMS

SILARX PHARMACEUTICALS, INC. UAD LABORATORIES INC SIRIUS LABORATORIES, INC. UCB PHARMA, INC. SJ PHARMACEUTICALS, LLC UCYCLYD PHARMA, INC. SKIN MEDICA UDL LABORATORIES, INC. SMITH & NEPHEW, INC. UNICO HOLDINGS, INC. SNUVA INCORPORATED UNIMED PHARMACEUTICALS, INC SOLSTICE NEUROSCIENCES, INC. UNITED RESEARCH LABORATORIES SOLVAY PHARMACEUTICALS, INC. UNITED THERAPEUTICS CORPORATION SOMERSET PHARMACEUTICALS INC UPSHER-SMITH LABORATORIES, INC. SPEAR DERMATOLOGY PRODUCTS, INC. UPSTATE PHARMA, LLC STAR PHARMACEUTICALS, INC. VALEANT PHARMACEUTICALS, INTERNATIONAL STAT-TRADE, INC. VANGARD LABS, INC. STEWART-JACKSON PHARMACAL, INC. VARSITY LABORATORIES STIEFEL LABORATORIES, INC, VATRING PHARMACEUTICALS, INC. STONEBRIDGE PHARMA, LLC VERACITY PHARMACEUTICALS, INC. STORZ INSTRUMENT COMPANY VERNALIS PHARMACEUTICALS, INC. STRATUS PHARMACEUTICALS INC. VERSAPHARM INCORPORATED SUMMIT PHARMACEUTICALS DBA ENEMEEZ, INC VERTICAL PHARMACEUTICALS, INC. SUN PHARMACEUTICAL INDUSTRIES, INC. VICTORY PHARMA, INC SUN PHARMACEUTICAL INDUSTRIES, LTD VINDEX PHARMACEUTICALS, INC. SYNTHON PHARMACEUTICALS, LTD. VINTAGE PHARMACEUTICALS, INC. TAKEDA PHARMACEUTICALS AMERICA, INC. VIRO PHARMA, INCORPORATED TALECRIS BIOTHERAPEUTICS, INC. VISION PHARMA, LLC TAP PHARMACEUTICALS INC VISTAKON PHARMACEUTICALS, LLC TARGACEPT VISTAPHARM, INC. TARO PHARMACEUTICALS USA, INC. VIVUS, INC. TAYLOR PHARMACEUTICALS WARNER CHILCOTT LABORATORIES TEAMM PHARMACEUTICALS, INC. WARRICK PHARMACEUTICALS TERCICA, INC. WATSON PHARMA, INC. TEVA NEUROSCIENCE, INC. WE PHARMACEUTICALS, INC. TEVA PHARMACEUTICALS USA, INC. WEST-WARD PHARMACEUTICAL CORP THAMES PHARMACEUTICALS, INC. WESTWOOD-SQUIBB PHARMACEUTICALS THE F. DOHMEN COMPANY WHITEHALL-ROBINS THE LIPOSOME COMPANY, INC. WOCKHARDT AMERICAS, INC. THE PROCTER & GAMBLE DISTRIBUTING CO. WRASER PHARMACEUTICALS THE REESE CHEMICAL COMPANY LABORATORIES THER-RX CORPORATION XANODYNE PHARMACEUTICAL, INC. THREE RIVERS PHARMACEUTICALS, LLC X-GEN PHARMACEUTICALS TIME-CAP LABS, INC. XTTRIUM LABORATORIES, INC. TOPIX PHARMACEUTICALS, INC. ZERXIS PHARMA, L.L.C. TOWER LABORATORIES, LTD ZILA PHARMACEUTICALS, INC. TRIAX PHARMACEUTICALS, LLC ZLB BEHRING TRIGEN LABORATORIES, INC. ZLB BEHRING LLC TRI-MED LABORATORIES, INC. ZYBER PHARMACEUTICALS, INC. U.S. PHARMACEUTICAL CORPORATION ZYDUS PHARMACEUTICALS (USA) INC.

MSA 07-33 Page 5 of 5 Attachment II