Quarterly Utilization Report (CMS-R-144)

MEDICAID DRUG REBATE PROGRAM

ELECTRONIC STATE INVOICE
Form CMS-R-144
RECORD FORMAT
Effective: July 1, 2021

Source: State Agencies
Target: CMS & Manufacturers
Ordinal Field (.TXT)
Positon Header Row (.CSV)

Size

Position

Remarks

1

Record ID

4

1-4

Constant of “FFSU” or “MCOU”

2

State Code

2

5-6

P.O. Abbreviation

3

Labeler Code

5

7 - 11

NDC 1

4

Product Code

4

12 -15

NDC 2

5

Package Size

2

16 - 17

NDC 3

6

Period Covered

5

18 - 22

QYYYY

7

FDA Product Name

10

23 - 32

Product name as appears on FDA
listing form. (1st 10 characters)

8

Unit Rebate Amount

15

33 - 47

99999999.999999

9

Units Reimbursed

16

48 - 63

999999999999.999

10

Rebate Amount Claimed

16

64 - 79

9999999999999.99

11

Number of Prescriptions

8

80 - 87

99999999

12

Medicaid Amount Reimbursed

16

88 - 103

9999999999999.99

13

Non-Medicaid Amount Reimbursed

16

104 - 119

9999999999999.99

14

Total Amount Reimbursed

16

120 - 135

9999999999999.99

15

Filler - State Invoice
Delete Flag - SDUD Submission to CMS

1

136 - 136

See Data Definitions