Drug Rebates. The Contractor shall ensure compliance with the requirements under Section 1927 of the Social Security Act. In accordance with the Affordable Care Act, manufacturers that participate in the Medicaid drug rebate program are required to pay rebates for drugs dispensed to individuals enrolled with a Medicaid Managed Care Organization. To facilitate collection of these rebates, FSSA shall include utilization data of Hoosier Healthwise MCEs when requesting quarterly rebates from manufacturers as well as in quarterly utilization reports to the Centers for Medicare and Medicaid Services (CMS). Thus, the Contractor shall timely submit their pharmacy encounter data completely and accurately to the State, in a manner required by the State. The Contractor shall comply with all file layout requirements including, but not limited to, format and naming conventions and submission of paid amounts. The State intends to use and share the Contractor paid amount information on the State’s pharmacy claim extracts for rebate purposes. Requirements for pharmacy encounter claims are outlined in Section 8.5. The report will include information on the total number of units of each dosage form, strength and package size by National Drug Code (NDC) of each covered outpatient drug dispensed to Contractor members and such other data that the Secretary of CMS determines necessary for the State to access rebates. This reporting shall include physician-administered drugs. For more information on reporting, please refer to Section 9, as well as the Hoosier Healthwise MCE Reporting Manual. The Contractor shall comply with 340B-related policies and procedures set forth in IHCP Provider Bulletin BT201754, and any updates thereto. The Contractor shall monitor claims for provider compliance of federal and state billing requirements pertaining to 340B-sourced drugs. The Contractor shall, at the request of the State, require providers to use 340B claims modifiers the State deems necessary to accurately assess rebates. Additionally, the Contractor shall assist OMPP or the State’s PBM Contractor in resolving drug rebate disputes with the manufacturer.
Drug Rebates. The Contractor shall ensure compliance with the requirements under Section 1927 of the Social Security Act. In accordance with the Affordable Care Act, manufacturers that participate in the Medicaid drug rebate program are required to pay rebates for drugs dispensed to individuals enrolled with a Medicaid Managed Care Organization. To facilitate collection of these rebates, FSSA must include utilization data of Hoosier Care Connect contractors when generating quarterly drug rebate invoices to manufacturers as well as reporting quarterly utilization statistics to the Centers for Medicare and Medicaid Services (CMS). The Contractor shall provide reports to the State to support rebate collection. This reporting shall include physician-administered drugs. The State intends to use and share the Contractor paid amount information on the State’s pharmacy claims extracts for rebate purposes. The Contractor shall provide this reporting to the State in the manner and timeframe prescribed by FSSA, including, but not limited to, through the submission of complete and accurate pharmacy encounter data and a rebate file to the State or its designee. An example of a rebate file is provided in the Bidder’s Library; this file layout is provided as an example only and is subject to change. Throughout the course of the Contract, FSSA may update the file layout to support rebate collection. FSSA shall make its best effort to provide the Contractor sixty (60) days advanced notice of the change and the Contractor shall be required to comply with the change in the timeframe designated by the State. The rebate file shall be posted to the State or its designee in the timeframe and manner to be specified by FSSA. The Contractor shall comply with all file layout requirements including, but not limited to, format and naming conventions and submission of paid amounts. Failure to comply with the drug rebate reporting requirements established by FSSA will subject the Contractor to the remedies outlined in Contract Exhibit 2. Requirements for pharmacy encounter claims are outlined in Section 8.6. Additionally, the Contractor shall assist FSSA or the State’s PBM contractor in resolving drug rebate disputes with a manufacturer, at Contractor’s expense.
Drug Rebates. The Contractor shall take all steps necessary to participate in, and support FSSA’s participation in, federal and supplemental drug rebate programs by terminating, and not entering into, rebate agreements with its Pharmacy Benefit Managers (PBMs) or with manufacturers for any drugs. The Contractor shall ensure compliance with the requirements under Section 1927 of the Social Security Act. In accordance with the Affordable Care Act, manufacturers that participate in the Medicaid drug rebate program are required to pay rebates for drugs dispensed to individuals enrolled with a Medicaid Managed Care Entity. To facilitate collection of these rebates, FSSA shall include utilization data of HIP contractors when requesting quarterly drug rebates from manufacturers as well as in quarterly utilization reports to the Centers for Medicare and Medicaid Services (CMS). The Contractor shall provide reports to the State to support rebate collection per 42 CFR 438.3(s)(2) and section 1927(b)(1)(A) of the Social Security Act. This reporting shall include physician-administered drugs. The State intends to use and share the Contractor paid amount information on the State’s pharmacy claims extracts for rebate purposes. The Contractor shall provide this reporting to the State in the manner and timeframe prescribed by FSSA, including, but not limited to, through the submission of complete and accurate pharmacy encounter data and a rebate file to the State or its designee. Per 42 CFR 438.3(s)(2) and section 1927(b)(1)(A) of the Social Security Act, the report will include information on the total number of units of each dosage form, strength, and package size by National Drug Code (NDC) of each covered outpatient drug dispensed to Contractor members and such other data that the Secretary of CMS determines necessary for the State to access rebates. This reporting shall include physician-administered drugs. For more information on reporting, please refer to Section 9, as well as the HIP MCE Reporting Manual. An example of a rebate file is provided in the Bidders’ Library; this file layout is provided as an example only and is subject to change. Throughout the course of the Contract, FSSA may update the file layout to support rebate collection. FSSA shall make its best effort to provide the Contractor sixty (60) days advanced notice of the change and the Contractor shall be required to comply with the change in the timeframe designated by the State. The Contractor shall comply with...
Drug Rebates. The Contractor shall ensure compliance with the requirements under Section 1927 of the Social Security Act. In accordance with the Affordable Care Act, manufacturers that participate in the Medicaid drug rebate program are required to pay rebates for drugs dispensed to individuals enrolled with a Medicaid Managed Care Entity. To facilitate collection of these rebates, FSSA must include utilization data of Hoosier Care Connect contractors when generating quarterly drug rebate invoices to manufacturers as well as reporting quarterly utilization statistics to the Centers for Medicare and Medicaid Services (CMS). The Contractor shall provide reports to the State to support rebate collection per 42 CFR 438.3(s)(2) and Section 1927(b)(1)(A) of the Social Security Act. This reporting shall include physician-administered drugs. The State intends to use and share the Contractor paid amount information on the State’s pharmacy claims extracts for rebate purposes. The Contractor shall provide this reporting to the State in the manner and timeframe prescribed by FSSA, including, but not limited to, through the submission of complete and accurate pharmacy encounter data and a rebate file to the State or its designee. An example of a rebate file is provided in the Bidders’ Library; this file layout is provided as an example only and is subject to change. Throughout the course of the Contract, FSSA may update the file layout to support rebate collection. FSSA shall make its best effort to provide the Contractor sixty (60) days advanced notice of the change and the Contractor
Drug Rebates. The Contractor shall take all steps necessary to participate in, and support FSSA’s participation in, federal and supplemental drug rebate programs by terminating, and not entering into, rebate agreements with its Pharmacy Benefit Managers (PBMs) or with manufacturers for any drugs. The Contractor shall ensure compliance with the requirements under Section 1927 of the Social Security Act. In accordance with the Affordable Care Act, manufacturers that participate in the Medicaid drug rebate program are required to pay rebates for drugs dispensed to individuals enrolled with a Medicaid Managed Care Entity. To facilitate collection of these rebates, FSSA must include utilization data of Hoosier Care Connect contractors when generating quarterly drug rebate invoices to manufacturers as well as reporting quarterly utilization statistics to the Centers for Medicare and Medicaid Services (CMS). The Contractor shall provide reports to the State to support rebate collection per 42 CFR 438.3(s)(2) and Section 1927(b)(1)(A) of the Social Security Act. The report will include information on the total number of units of each dosage form, strength and package size by National Drug Code (NDC) of each covered outpatient drug dispensed to Contractor members and such other data that the Secretary of CMS determines necessary for the State to access rebates. This reporting shall include physician-administered drugs. For more information on reporting, please refer to Section 9, as well as the Hoosier Care Connect MCE
Drug Rebates. The Contractor shall take all steps necessary to participate in, and support FSSA’s participation in, federal and supplemental drug rebate programs by terminating, and not entering into, rebate agreements with its Pharmacy Benefit Managers (PBMs) or with manufacturers for any drugs. The Contractor shall ensure compliance with the requirements under Section 1927 of the Social Security Act. In accordance with the Affordable Care Act, manufacturers that participate in the Medicaid drug rebate program are required to pay rebates for drugs dispensed to individuals enrolled with a Medicaid Managed Care Organization. To facilitate collection of these rebates, FSSA shall include utilization data of PathWays MCEs when requesting quarterly rebates from manufacturers as well as in quarterly utilization reports to the Centers for Medicare and Medicaid Services (CMS). Thus, the Contractor shall timely submit their pharmacy encounter data completely and accurately to the State, in a manner required by the State. The Contractor shall provide reports to the State to support rebate collection per 42 CFR 438.3(s)(2) and Section 1927(b)(1)(A) of the Social Security Act. The report will include information on the total number of units of each dosage form, strength and package size by National Drug Code (NDC) of each covered outpatient drug dispensed to Contractor members and such other data that the Secretary of CMS determines necessary for the State to access rebates. This reporting shall include physician-administered drugs. For more information on reporting, please refer to Section 10, as well as the PathWays MCE Reporting Manual. The Contractor shall comply with all file layout requirements including, but not limited to, format and naming conventions and submission of paid amounts. The State intends to use and share the Contractor paid amount information on the State’s pharmacy claim extracts for rebate purposes. Requirements for pharmacy encounter claims are outlined in Section 9.8. Per 42 CFR 438.3(s)(2) and section 1927(b)(1)(A) of the Social Security Act, the report will include information on the total number of units of each dosage form, strength and package size by National Drug Code (NDC) of each covered outpatient drug dispensed to Contractor members and such other data that the Secretary of CMS determines necessary for the State to access rebates. This reporting shall include physician-administered drugs. For more information on reporting, please refer to Sectio...
Drug Rebates. The Contractor shall take all steps necessary to participate in, and support FSSA’s participation in, federal and supplemental drug rebate programs by terminating, and not entering into, rebate agreements with its Pharmacy Benefit Managers (PBMs) or with manufacturers for any drugs. The Contractor shall ensure compliance with the requirements under Section 1927 of the Social Security Act. In accordance with the Affordable Care Act, manufacturers that participate in the Medicaid drug rebate program are required to pay rebates for drugs dispensed to individuals enrolled with a Medicaid Managed Care Entity. To facilitate collection of these rebates, FSSA must include utilization data of Hoosier Healthwise contractors when generating quarterly drug rebate invoices to manufacturers as well as reporting quarterly utilization statistics to the Centers for Medicare and Medicaid Services (CMS). The Contractor shall provide reports to the State to support rebate collection.
Drug Rebates. The Contractor shall ensure compliance with the requirements under Section 1927 of the Social Security Act. In accordance with the Affordable Care Act, manufacturers that participate in the Medicaid drug rebate program are required to pay rebates for drugs dispensed to individuals enrolled with a Medicaid Managed Care Organization. To facilitate collection of these rebates, FSSA shall include utilization data of Hoosier Healthwise MCEs when requesting quarterly rebates from manufacturers as well as in quarterly utilization reports to CMS. Thus, the Contractor shall timely submit their pharmacy encounter data completely and accurately to the State, in a manner required by the State. The Contractor shall comply with all file layout requirements including, but not limited to, format and naming conventions and submission of paid amounts. The State intends to use and share the Contractor paid amount information on the State’s pharmacy claim extracts for rebate purposes. Requirements for pharmacy encounter claims are outlined in Section 8.5. The report will include information on the total number of units of each dosage form, strength and package size by National Drug Code (NDC) of each covered outpatient drug dispensed to Contractor members and such other data that the Secretary of CMS determines necessary for the State to access rebates. This reporting shall include physician- administered drugs. For more information on reporting, please refer to Section 9, as well as the Hoosier Healthwise MCE Reporting Manual. The Contractor shall comply with policies and procedures set forth the IHCP Provider Bulletin regarding use of 340b covered entities dated April 1, 2014 (BT201413), and any updates thereto. Additionally, the Contractor shall assist OMPP or the State’s PBM Contractor in resolving drug rebate disputes with the manufacturer.
Drug Rebates. The Contractor shall ensure compliance with the requirements under Section 1927 of the Social Security Act. In accordance with the Affordable Care Act, manufacturers that participate in the Medicaid drug rebate program are required to pay rebates for drugs dispensed to individuals enrolled with a Medicaid Managed Care Entity. To facilitate collection of these rebates, FSSA must include utilization data of Hoosier Healthwise contractors when generating quarterly drug rebate invoices to manufacturers as well as reporting quarterly utilization statistics to the Centers for Medicare and Medicaid Services (CMS). The Contractor shall provide reports to the State to support rebate collection. This reporting shall include physician-administered drugs per 42 CFR 438.3(s)(2) and section 1927(b)(1)(A) of the Social Security Act.
Drug Rebates. The Contractor shall submit all pharmacy encounters with the exception of in- patient hospital pharmacy encounters to the DMAHS and the DMAHS shall submit these pharmacy encounters for rebate from manufacturers and the Secretary pursuant to the Section 2501 of the Patient Protection and Affordable Care Act (PPACA) effective from a March 23, 2010 date of service. The Contractor shall submit such pharmacy encounters also for CHIP enrollees.
