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 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 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 must include utilization data of Hoosier Care Connect 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 drugsdrugs per 42 CFR 438.3(s)(2) and section 1927(b)(1)(A) of the Social Security Act. 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 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 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 22 Contract Compliance and Pay for Outcomes. 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. As maximization of drug rebates is heavily dependent on cooperation by the Contractor with the State or the State’s designated rebate vendor, the Contractor must respond to all inquiries from the State or the vendor pertaining to all drug rebate matters in a timely fashion. The Contractor must acknowledge receipt of such inquiries in writing (e.g., by e-mail) within two (2) business days of receipt, and in that acknowledgement provide a best estimate of when a final response will be provided.

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 OrganizationEntity. 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 collectioncollection 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 Bidder’s 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 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 22 Contract Compliance and Pay for Outcomes. 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. As maximization of drug rebates is heavily dependent on cooperation by the Contractor with the State or the State’s designated rebate vendor, the Contractor must respond to all inquiries from the State or the vendor pertaining to all drug rebate matters in a timely fashion. The Contractor must acknowledge receipt of such inquiries in writing (e.g., by e-mail) within two (2) business days of receipt, and in that acknowledgement provide a best estimate of when a final response will be provided.

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 OrganizationEntity. To facilitate collection of these rebates, FSSA must include utilization data of Hoosier Care Connect HIP 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 collectioncollection 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 Bidder’s 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 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 22 Contract Compliance and Pay for Outcomes. 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. As maximization of drug rebates is heavily dependent on cooperation by the Contractor with the State or the State’s designated rebate vendor, the Contractor must respond to all inquiries from the State or the vendor pertaining to all drug rebate matters in a timely fashion. The Contractor must acknowledge receipt of such inquiries in writing (e.g., by e- mail) within two (2) business days of receipt, and in that acknowledgement provide a best estimate of when a final response will be provided.

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 OrganizationEntity. 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 EXHIBIT 1 SCOPE OF WORK 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 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 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 22 Contract Compliance and Pay for Outcomes. 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. As maximization of drug rebates is heavily dependent on cooperation by the Contractor with the State or the State’s designated rebate vendor, the Contractor must respond to all inquiries from the State or the vendor pertaining to all drug rebate matters in a timely fashion. The Contractor must acknowledge receipt of such inquiries in writing (e.g., by e- mail) within two (2) business days of receipt, and in that acknowledgement provide a best estimate of when a final response will be provided.

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 OrganizationEntity. To facilitate collection of these rebates, FSSA must include utilization data of Hoosier Care Connect Connect EXHIBIT 1. A. SCOPE OF WORK 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 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 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 22 Contract Compliance and Pay for Outcomes. 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. As maximization of drug rebates is heavily dependent on cooperation by the Contractor with the State or the State’s designated rebate vendor, the Contractor must respond to all inquiries from the State or the vendor pertaining to all drug rebate matters in a timely fashion. The Contractor must acknowledge receipt of such inquiries in writing (e.g., by e- mail) within two (2) business days of receipt, and in that acknowledgement provide a best estimate of when a final response will be provided.

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 EXHIBIT 1.M SCOPE OF WORK 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 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 must include utilization data of Hoosier Care Connect EXHIBIT 1 SCOPE OF WORK 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 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 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 22 Contract Compliance and Pay for Outcomes. 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. As maximization of drug rebates is heavily dependent on cooperation by the Contractor with the State or the State’s designated rebate vendor, the Contractor must respond to all inquiries from the State or the vendor pertaining to all drug rebate matters in a timely fashion. The Contractor must acknowledge receipt of such inquiries in writing (e.g., by e- mail) within two (2) business days of receipt, and in that acknowledgement provide a best estimate of when a final response will be provided.