Common use of Pharmacy Rebates Clause in Contracts

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. The State state may propose a methodology for assigning a portion of pharmacy rebates to the Demonstrationdemonstration. 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 demonstration vs. outside the Demonstrationdemonstration, 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 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.