What does receiving a rejected claim stating "NDC Not Covered" indicate?

Receiving a rejected claim with the statement "NDC Not Covered" signifies that the medication associated with the National Drug Code (NDC) is not included in the insurance plan's formulary. A closed formulary typically limits coverage to certain drugs, often within specific therapeutic categories, meaning that if a medication is not on the list of approved drugs, the insurance plan will not provide reimbursement for it.

This situation often occurs with specialty medications or newer drugs that have not yet been reviewed for inclusion in a particular plan's formulary. For patients, this means they may need to consider alternative medications that are covered under their plan or discuss options with their healthcare provider.

The other choices, such as the claim being submitted after the expiration date, medication not in stock, or the patient not having met their deductible, do not specifically relate to the rejection message regarding the NDC, as they involve different aspects of the claims process.