What does a rejected claim labeled "NDC Not Covered" most commonly suggest?

A rejected claim labeled "NDC Not Covered" most commonly indicates that the prescription drug's National Drug Code (NDC) is not included in the insurance plan's formulary. Insurance plans can have closed formularies, which means they only cover a specific list of medications. If a medication prescribed is not part of that list, it will result in a claim rejection with the "NDC Not Covered" label.

In the context of a closed formulary, this restriction is a cost-control measure to encourage the use of preferred drugs that are typically more cost-effective for the insurer. When a patient requires a medication that falls outside of the included options, the claim will not be approved, leading to this specific rejection message. This situation necessitates communication with the healthcare provider to either find an alternative medication that is covered or obtain prior authorization if the drug is deemed essential for treatment.