Drug Appendices Description
Drug Appendix A
(PDF Format)
A - New list of payable drugs on drug file.
Drug Appendix A-1
(PDF Format)
A-1 - Average Acquisition Cost (AAC) rates published by Myers and Stauffer
Drug Appendix B
(PDF Format)
B - New list of DESI Drugs by NDC which are not reimbursable.
Drug Appendix C
(PDF Format)
C - New list of Labelers approved for rebate. Their products may be covered only if on Appendix A and not on Appendix B and if not declared obsolete by manufacturer or CMS).
Drug Appendix E-1
(PDF Format)
E-1 - This PDF is a listing of products with quantity limits as of October 13, 2017.
Drug Appendix E-2
(PDF Format)
E-2 - This PDF is a listing of products with maximum daily dosages as of October 13, 2017..