Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 27 - Department of Medical Services › Rule 016.27.22-002 - Preferred Drug List Pool and Value-Based Purchasing

Current through Register Vol. 49, No. 6, June, 2024
STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT
				MEDICAL ASSISTANCE PROGRAM STATE ARKANSAS
AMOUNT, DURATION AND SCOPE OF SERVICES
				PROVIDED
CATEGORICALLY NEEDY
ATTACHMENT 3.1-A
Revised: May 1, 2022
12. Prescribed drugs, dentures and prosthetic
			 devices; and eyeglasses prescribed by a physician skilled in diseases of the
			 eye or by an optometrist
a. Prescribed Drugs
(4) The state is in compliance with section
			 1927 of the Social Security Act. The state will cover drugs of Federal rebate
			 participating manufacturers. The state is in compliance with reporting
			 requirements for utilization and restrictions to coverage. Pharmaceutical
			 manufacturers can audit utilization data.
The state will be negotiating supplemental rebates in the
				Medicaid program in addition to the Federal rebates provided for in Title XIX.
				Rebate agreements between the state and pharmaceutical manufacturer(s) will be
				separate from the Federal rebates.
Effective May 1, 2022, CMS has authorized the state of
				Arkansas to enter into a multi-state supplemental rebate pool, using a
				Preferred Drug List (PDL) to maximize state supplemental rebates. The state
				will continue to select products participating in the federal rebate program
				that will be in its Preferred Drug List Program and will only receive state
				supplemental rebates for manufacturer's supplemental covered products included
				on the PDL.
A rebate agreement between the state and a participating drug
				manufacturer for drugs provided to the Medicaid program, submitted to CMS on
				May 24, 2016, and entitled, State of Arkansas Supplemental Rebate Agreement,
				has been authorized by CMS. Any additional versions of rebate agreements
				negotiated between the state and manufacturer(s) after May 24, 2016, will be
				submitted to CMS for authorization.
The state supplemental rebate agreements would apply to the
				drug benefit, both fee-for-service and those paid by contracted Medicaid
				managed care organizations (MCOs), under prescribed conditions in Attachment C
				of the State of Arkansas Supplemental Rebate Agreement. State supplemental
				rebate agreements would apply to beneficiaries, including those made eligible
				under the Affordable Care Act receiving fee-for-service benefits and those that
				are enrolled under a Medicaid managed care organization agreement.
Supplemental rebates received by the State in excess of those
				required under the National Drug Rebate Agreement will be shared with the
				Federal government on the same percentage basis as applied under the national
				rebate agreement.
All drugs covered by the program, irrespective of a
				supplemental rebate agreement, will comply with the provisions of the national
				drug rebate agreement.
The supplemental rebate program does not establish a drug
				formulary within the meaning of 1927(d)(4) of the Social Security Act.
Effective May 1, 2022, CMS has authorized the state of
				Arkansas to enter into value/outcomes-based contracts with manufacturers on a
				voluntary basis. The conditions of the value/outcomes-based contract would be
				agreed upon by both the state and manufacturer.
The unit rebate amount is confidential and cannot be disclosed
				for purposes other than rebate invoicing and verification, in accordance with
				Section 1927(b)(3)(D) of the Social Security Act.
(5) Pursuant to
			 42 U.S.C. Section
			 1396r-8 the state is establishing a preferred
			 drug list with prior authorization for drugs not included on the preferred drug
			 list. Prior authorization will be provided within a 24-hour turn-around from
			 receipt of request and a 72-hour supply of drugs in emergency
			 situations.