Common use of Drug Rebates Clause in Contracts

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 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 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 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 must include utilization data of HIP Hoosier Healthwise contractors when requesting generating quarterly drug rebates from rebate invoices to manufacturers as well as in reporting quarterly utilization reports statistics to the Centers for Medicare and Medicaid Services (CMS). The Contractor shall provide reports to the State to support rebate collection 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. 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 Hoosier Healthwise 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 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 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 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 must include utilization data of HIP Hoosier Healthwise contractors when requesting generating quarterly drug rebates from rebate invoices to manufacturers as well as in reporting quarterly utilization reports statistics to the Centers for Medicare and Medicaid Services (CMS). The Contractor shall provide reports to the State to support rebate collection 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. 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 Hoosier Healthwise 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 bes t 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 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 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 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 must include utilization data of HIP Hoosier Healthwise contractors when requesting generating quarterly drug rebates from rebate invoices to manufacturers as well as in reporting quarterly utilization reports statistics to the Centers for Medicare and Medicaid Services (CMS). The Contractor shall provide reports to the State to support rebate collection 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. 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 Hoosier Healthwise 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 i ts 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 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 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 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 must include utilization data of HIP Hoosier Healthwise contractors when requesting generating quarterly drug rebates from rebate invoices to manufacturers as well as in reporting quarterly utilization reports statistics to the Centers for Medicare and Medicaid Services (CMS). The Contractor shall provide reports to the State to support rebate collection 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. 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 Hoosier Healthwise 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 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 2.B 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.