Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 121 - PHARMACEUTICAL SERVICES › Section 410-121-0157 - Participation in the Medicaid Drug Rebate Program

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Oregon Medicaid Pharmaceutical
			 Services Program is a participant in the Centers for Medicare and Medicaid
			 Services (CMS) Medicaid Drug Rebate Program, created by the Omnibus Budget
			 Reconciliation Act (OBRA) of 1990. The Patient Protection and Affordable Care
			 Act (PPACA) enacted on March 23,2010 and the Health Care and Education
			 Reconciliation Act of 2010, (HCERA) enacted on March 30, 2010, together called
			 the Affordable Care Act, requires the Division to collect drug rebates for
			 covered outpatient drugs dispensed to enrollees of Medicaid managed care
			 organizations, (MCOs). The Medicaid Drug Rebate Program requires a drug
			 manufacturer to enter into and have in effect a national rebate agreement with
			 the Secretary of the Department of Health and Human Services for States to
			 receive federal funding for outpatient drugs dispensed to Medicaid patients.
			 The drug rebate program is administered by CMS's Center for Medicaid and State
			 Operations (CMSO). Pharmaceutical companies participating in this program have
			 signed agreements with CMS to provide rebates to the Division of Medical
			 Assistance Programs (Division) on all their drug products. The Division will
			 reimburse providers only for outpatient drug products manufactured or labeled
			 by companies participating in this program.
(2) Documents in rule by reference: Names and
			 Labeler Code numbers for participants in the Medicaid Drug Rebate Program are
			 the responsibility of and maintained by CMS. The Division receives this
			 information from CMS in the form of numbered and dated Releases. The Division
			 includes in rule by reference, the CMS Releases online at:
			 https://www.medicaid.gov/medicaid/prescription-drugs/program-releases/index.html
			 [File Link Not Available].
(3)
			 Retroactive effective dates: The CMS Medicaid Drug Rebate Program experiences
			 frequent changes in participation and often this information is submitted to
			 the Division after the effective date(s) of some changes. Therefore, certain
			 participant additions and deletions may be effective retroactively. See
			 specific instructions in the CMS Releases for appropriate effective date(s) of
			 changes.
(4) The Division contracts
			 with a Pharmacy Benefit Manager (PBM) to manage the Medicaid Rebate Dispute
			 Resolution program. Pharmacy providers must verify the accuracy of their
			 Medicaid pharmacy claims with the PBM within 30 days of request in instances
			 where drug manufacturers dispute their claim information. Verification can be
			 photocopies of drug invoices showing that the billed products were in stock
			 during the time of the date of service.
(5) The actual National Drug Code (NDC)
			 dispensed and the actual metric decimal quantity dispensed, must be
			 billed.
Statutory/Other Authority: ORS
				  413.042 & 414.065
Statutes/Other Implemented: ORS
				  414.065