Certification of Pharmacy Technicians (ExCPT) Practice Exam

When a technician encounters a rejected claim labeled "NDC Not Covered," it typically indicates that the specific National Drug Code (NDC) of the medication is not included in the insurance plan's formulary. A closed formulary is a list of medications that the insurance company agrees to cover, and it often excludes certain drugs. If an NDC is not covered, it suggests that this particular medication is not part of that approved list, which is characteristic of a closed formulary.

In contrast, an open formulary generally includes a broader range of medications, often allowing for more options to be covered. Other potential issues such as mismatched birth dates or the nature of the patient's insurance coverage (like single coverage) do not directly lead to a rejection due to the NDC specification. Thus, a rejection for "NDC Not Covered" primarily signals that the drug is not part of the plan's approved listings.