Supplemental Rebate Agreement Sample Contracts

SUPPLEMENTAL REBATE AGREEMENT
Supplemental Rebate Agreement • January 7th, 2021 • Maine
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SUPPLEMENTAL REBATE AGREEMENT Company Name
Supplemental Rebate Agreement • May 5th, 2020 • Utah

This Supplemental Rebate Agreement (“Agreement”) is dated as of this 1st day of January by and between the State of Utah Department of Health, Division of Medicaid and Health Financing (“State”) and (“Pharmaceutical Manufacturer”).

State of Oregon SUPPLEMENTAL REBATE AGREEMENT
Supplemental Rebate Agreement • May 5th, 2020 • Oregon

This Agreement is between the State of Oregon, acting by and through the Oregon Health Authority, Division of Medical Assistance Programs (“DMAP”) and

Delaware State Supplemental Rebate Agreement And
Supplemental Rebate Agreement • May 17th, 2017 • Delaware

The Delaware Department of Health and Social Services, Division of Medicaid and Medical Assistance (hereinafter “Department” or “DMMA”) and Manufacturer have entered into this Agreement for the purpose of establishing a State Supplemental Rebate for utilization of the Manufacturer’s Preferred Product(s) by Delaware Medicaid recipients, which will be in addition to rebates received under the National Drug Rebate Agreement, pursuant to Section 1927 of the Social Security Act (“the Act”), 42 U.S.C. § 1396r-8. The parties intend for this Agreement to meet the requirements of 42 U.S.C. § 1396r-8.

Supplemental Rebate Agreement Reporting
Supplemental Rebate Agreement • January 31st, 2023

In Nevada, three managed care organizations and/or their pharmacy benefit managers entered into rebate agreements and contracts to purchase prescription drugs included on the list of preferred prescription drugs for health plans under the Medicaid program. A pharmacy benefit manager enters into rebate agreements on behalf of the Fee-for-Service Medicaid program. A summary of these agreements is provided in Table 1 below.

Delaware State Supplemental Rebate Agreement And
Supplemental Rebate Agreement • March 22nd, 2024 • Delaware

The Delaware Department of Health and Social Services, Division of Medicaid and Medical Assistance (hereinafter “Department” or “DMMA”) and MANUFACTURER (Manufacturer) have entered into this Agreement for the purpose of establishing a State Supplemental Rebate for utilization of the Manufacturer’s Preferred Product(s) by Delaware Medicaid recipients, which will be in addition to rebates received under the National Drug Rebate Agreement, pursuant to Section 1927 of the Social Security Act (“the Act”), 42 U.S.C. § 1396r-8. The parties intend for this Agreement to meet the requirements of 42

SUPPLEMENTAL REBATE AGREEMENT
Supplemental Rebate Agreement • October 10th, 2011 • Oklahoma

Based upon the following recitals, the Oklahoma Health Care Authority (hereinafter referred to as “OHCA”) and , F.E.I# _ _ - , (hereinafter referred to as “Manufacturer”), enter into this agreement.

Agreement Number 000000
Supplemental Rebate Agreement • March 23rd, 2017 • Oregon

In compliance with the Americans with Disabilities Act, this document is available in alternate formats such as Braille, large print, audiotape, oral presentation and electronic format. To request an alternate format, please send an e-mail to dhs-oha.publicationrequest@state.or.us or contact the Office of Document Management at 503-378-3486 (voice), and TTY at 503-378-3523.

SUPPLEMENTAL REBATE AGREEMENT
Supplemental Rebate Agreement • April 30th, 2024 • Maine
SUPPLEMENTAL REBATE AGREEMENT
-+Supplemental Rebate Agreement • May 5th, 2020 • Maine

WHEREAS, the State has the authority to enter into agreements with pharmaceutical manufacturers to collect supplemental rebates for the benefit of the State’s Medicaid members providing such agreements are authorized by the Centers for Medicare & Medicaid Services (CMS); and

SUPPLEMENTAL REBATE AGREEMENT
Supplemental Rebate Agreement • April 18th, 2024 • Utah

This Supplemental Rebate Agreement (“Agreement”) is dated as of this day of , , by and between the State of Utah Department of Health & Human Services, Division of Integrated Healthcare (“State”) and (Manufacturer).

Supplemental Rebate Agreement Reporting
Supplemental Rebate Agreement • January 14th, 2022

In Nevada, three managed care organizations enter into rebate agreements to purchase prescription drugs for health plans under the Medicaid program. A pharmacy benefit manager enters into rebate agreements on behalf of the fee-for-service Medicaid program. A summary of these agreements is provided in Table 1 below.

Supplemental Rebate Agreement
Supplemental Rebate Agreement • May 14th, 2020 • Illinois

The State of Illinois, acting by and through the Illinois Department of Healthcare and Family Services, 201 South Grand Avenue East, Springfield, Illinois 62763-0001 (hereinafter referred to as "Department"), and Sample Contract, located at 10 Test Dr, Test City, IL 12345, (hereinafter referred to as "Manufacturer"), hereby enter into the following Supplemental Rebate Agreement effective January 1, 2020.

Contract
Supplemental Rebate Agreement • May 15th, 2019 • Louisiana

This Supplemental Rebate Agreement (“Agreement”), by and between the State of Louisiana, Department of Health, hereinafter referred to as the “State” and «Current_Legal_Company_Name», hereinafter referred to as the “Manufacturer”, is for the provision of STATE OF LOUISIANA SUPPLEMENTAL REBATES, as further defined below.

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