Pharmacy Rebates. The State may propose a methodology for assigning a portion of pharmacy rebates to the Demonstration, in a way that reasonably reflects the actual rebate-eligible pharmacy utilization of the Demonstration population, and which reasonably identifies pharmacy rebate amounts with DYs. Use of the methodology is subject to the approval in advance by the CMS Regional Office, and changes to the methodology must also be approved in advance by the Regional Office. The portion of pharmacy rebates assigned to the Demonstration using the approved methodology will be reported on the appropriate Form CMS-64.9 Waiver for the Demonstration, and not on any other CMS-64.9 form (to avoid double-counting). Each rebate amount must be distributed as State and Federal revenue consistent with the Federal matching rates under which the claim was paid.
Pharmacy Rebates. The State may propose a methodology for assigning a portion of pharmacy rebates to the Demonstration. The proposed methodology must determine, in a way that reasonably reflects actual rebate-eligible pharmacy utilization, the amounts of rebate that are attributable to pharmacy utilization under the Demonstration vs. outside the Demonstration, and appropriate subtotals by EG and DY. The methodology (and any subsequent changes to the methodology) must be approved in advance by the CMS Regional Office prior to use. Rebate amounts assigned to the Demonstration must be reported on the appropriate Forms CMS-64.9 or 64.9P Waiver, and not on any other CMS-64.9 form (to avoid double-counting). In the absence of an approved methodology, all pharmacy rebates must be reported on Forms CMS-64.9 or 64.9P Base.
Pharmacy Rebates. Pharmacy rebates must be reported on Form CMS-64.9 Base, and not allocated to any Form 64.9 or 64.9P Waiver.
Pharmacy Rebates. Based on an analysis of CY 2017 annual cost report data, retail pharmacy expenditures were reduced by supplemental rebates assumed to be collected by the MCPs. We reviewed CY 2017 historical experience period to assess a reasonably attainable level of supplemental pharmacy rebates. No adjustment for pharmacy rebates was made to the MAT therapeutic class due to ODM’s efforts to standardize drug dispensing for this therapeutic class. Supplemental rebates are assumed to vary by population from approximately 3.0% to 6.0% of total pharmacy expenditures.
Pharmacy Rebates. 3.5.12.1.1 Pursuant to Section 1927 of the Social Security Act, drug manufacturers must pay rebates for covered outpatient drugs reimbursed under Medicaid, including those provided by MCOs. Pursuant to Section 1927(a)(7) of the Social Security Act, states must collect Medicaid rebates for physician administered drugs. In addition to the Medicaid Drug Rebate Program required by Section 1927 of the Social Security Act, Delaware has received CMS approval to enter into Supplemental Drug Rebate agreements, and the State has amended these agreements to include utilization from MCOs.
Pharmacy Rebates. Based on an analysis of CY 2018 annual cost report data as well as MCP-reported rebate information, retail pharmacy expenditures were reduced by supplemental rebates assumed to be collected by the MCPs for drug therapeutic classes not included on the unified PDL. Drug classes for which supplemental rebates are assumed to continue to be collected include blood glucose meters and test strips. We reviewed CY 2018 historical experience period to assess a reasonably attainable level of supplemental pharmacy rebates for these classes, while assuming no supplemental rebates would be retained for other classes.
Pharmacy Rebates. When claiming these expenditures the Commonwealth may refer to the July 24, 2014 CMCS Informational Bulletin which contains clarifying information for quarterly reporting of Medicaid Drug Rebates in the Medicaid Budget and Expenditures (MBES) (xxxx://xxx.xxxxxxxx.xxx/Federal-Policy- Guidance/downloads/CIB-07-24- 2014.pdf). The Commonwealth must adhere to the requirement at section 2500.1 of the State Medicaid Manual that all state collections, including drug rebates, must be reported on the CMS-64 at the applicable Federal Medical Assistance Percentage (FMAP) or other matching rate at which related expenditures were originally claimed. Additionally, we are specifying that states unable to tie drug rebate amounts directly to individual drug expenditures may utilize an allocation methodology for determining the appropriate Federal share of drug rebate amounts reported quarterly. This information identifies the parameters that states are required to adhere to when making such determinations. Additionally, this information addresses how states must report drug rebates associated with the new adult eligibility group described at 42 CFR 435.119. States that adopt the new adult group may be eligible to claim drug expenditures at increased matching rates. Drug rebate amounts associated with these increased matching rates must be reported at the same matching rate as the original associated prescription drug expenditures.
Pharmacy Rebates. We reviewed the supplemental pharmacy rebate amounts reported by the MCPs in both the 2019 annual cost report submissions as well as the 2019 MCP Survey in order to estimate amounts attributable to retail pharmacy drug classes not included in the Unified Prescription Drug List (PDL) during the CY 2021 rating period. Due to the addition of blood glucose test strips and meters to the PDL for CY 2021, we estimate that the impact of supplemental pharmacy rebates will be immaterial for the CY 2021 rating period. As a result, no adjustments were applied for consideration of supplemental pharmacy rebates.
Pharmacy Rebates. The State may propose a methodology for assigning a portion of pharmacy rebates to the Demonstration, in a way that reasonably reflects the actual rebate- eligible pharmacy utilization of the Demonstration population, and which reasonably identifies pharmacy rebate amounts with DYs. Use of the methodology is subject to the approval in advance by the CMS Regional Office, and changes to the methodology must also be approved in advance by the Regional Office. The portion of pharmacy rebates assigned to the Demonstration using the approved methodology will be reported on the appropriate Forms CMS-64.9 Waiver for the Demonstration, and not on any other CMS-
Pharmacy Rebates. Based on an analysis of CY 2015 annual cost report data, retail pharmacy expenditures were reduced by the reported supplemental rebate percentage during the CY 2015 historical experience period. For the AFK population, we assumed an amount of Pharmacy Rebates consistent with reported values for the CFC and ABD child populations.
