What does the claim rejection "NDC Not Covered" generally mean?

When a claim rejection states "NDC Not Covered," it typically indicates that the National Drug Code (NDC) submitted does not appear in the insurance plan's covered medications. This situation often arises in the context of a closed formulary, where the insurance plan only covers specific drugs that are listed within its formulary. If a medication's NDC is not included in this restricted list, it will result in a rejection because the plan does not authorize payment for that particular drug.

A closed formulary is designed to control costs and manage the types of medications that are available to patients under that specific insurance plan. On the other hand, an open formulary would include a broader range of medications, allowing for greater flexibility and increased options for patients. The other options relate to different issues, such as mismatched patient information or the use of mail-order services, which do not address the specific context of the NDC rejection related to formulary coverage.