Common use of Drug Rebates Clause in Contracts

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 shall include utilization data of Hoosier Healthwise HIP 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 8.511.6. 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-physician- administered drugs. For more information on reporting, please refer to Section 912, as well as the Hoosier Healthwise HIP 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 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 OrganizationEntity. To facilitate collection of these rebates, FSSA shall must include utilization data of Hoosier Healthwise MCEs Care Connect contractors when requesting generating quarterly rebates from drug rebate invoices to manufacturers as well as in reporting quarterly utilization reports statistics 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 provide reports to the State to support rebate collection per 42 CFR 438.3(s)(2) and naming conventions and submission Section 1927(b)(1)(A) 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 8.5Social 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 Healthwise Care Connect MCE Reporting Manual. 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 shall be required to comply with the change in the timeframe designated by the State. The Contractor shall comply with 340B-related policies all file layout requirements including, but not limited to, format and procedures set forth in IHCP Provider Bulletin BT201754, naming conventions and any updates theretosubmission of paid amounts. The Contractor shall monitor claims for provider compliance of federal and state billing Failure to comply with the drug rebate reporting 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, established by FSSA will subject the Contractor shall assist OMPP or to the State’s PBM Contractor remedies outlined in resolving drug rebate disputes with the manufacturer.Contract Exhibit 2.E Contract Compliance and Pay for Outcomes. Requirements EXHIBIT 1. E SCOPE OF WORK

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 tracts 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 Addition drug rebate disputes with the manufacturer.

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 OrganizationEntity. To facilitate collection of these rebates, FSSA shall must include utilization data of Hoosier Healthwise MCEs Care Connect contractors when requesting generating quarterly rebates from drug rebate invoices to manufacturers as well as in reporting quarterly utilization reports statistics 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 provide reports to the State to support rebate collection per 42 CFR 438.3(s)(2) and naming conventions and submission Section 1927(b)(1)(A) 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 8.5Social 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 Healthwise Care Connect MCE Reporting Manual. 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 shall be required to comply with the change in the timeframe designated by the State. The Contractor shall comply with 340B-related policies all file layout requirements including, but not limited to, format and procedures set forth 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 IHCP Provider Bulletin BT201754, Contract Exhibit 2.E Contract Compliance and any updates theretoPay for Outcomes. The Contractor shall monitor Requirements for pharmacy encounter 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 rebatesare outlined in Section 8.6. Additionally, the Contractor shall assist OMPP FSSA or the State’s PBM Contractor contractor in resolving drug rebate disputes with the a manufacturer, at Contractor’s expense.