OAR 410-121-0032
Supplemental Rebate Agreements


(1)

The Division has a Centers for Medicare & Medicaid Services (CMS) approved Supplemental Rebate Agreement. This template and instructions are available on the Oregon Health Authority’s (Authority) web site at: http:/­/­www.oregon.gov/­OHA/­HSD/­OHP/­tools/­Model%20Supplemental%20Rebate%20Agreement.pdf.

(2)

The Division negotiates Supplemental Rebate Agreements for specific drug products through the Sovereign States Drug Consortium (SSDC) multi-state pool and pharmaceutical manufacturers. Negotiations are confidential, and shall not be disclosed, except in connection with an agreement/contract or as may be required by law. Confidentiality is required of any third party involved in administration of the agreement/contract.

(3)

Manufacturers may submit supplemental rebate offers for consideration to include their drug(s) on the Practitioner’s-Managed Prescription Drug Plan (PMPDP) Preferred Drug List (PDL), OAR 410-121-0030 (Practitioner-Managed Prescription Drug Plan) after gaining access to the SSDC secure web-based offer entry system.

(4)

Manufacturers must abide by requirements of the SSDC.

(5)

The Practitioner-Managed Prescription Drug List (PMPDP) also called the Preferred Drug List (PDL) consist of drugs after the Food and Drug Administration (FDA) has determined to be safe and effective and reimbursable as determined by the Centers for Medicaid and Medicare Services (CMS), and evaluated using an evidence-based review process by the Pharmacy & Therapeutics Committee (P&T). If pharmaceutical manufacturers enter into supplemental rebate agreements with the SSDC, the Authority may include that drug on the PDL.

(6)

Acceptance of the offer:

(a)

The Division may accept an offer through the SSDC;

(b)

The SSDC will notify manufacturers of the status of their offer(s).

(c)

Supplemental Agreements will be executed after signed by all parties, approved by CMS if required, and added to the PMPDP Preferred Drug List by the Administrative rule process.

(d)

The Division may contract for the functions of tracking utilization, invoicing, and dispute resolution for supplemental rebate products.

Source: Rule 410-121-0032 — Supplemental Rebate Agreements, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=410-121-0032.

410‑121‑0000
Foreword and Definition of Terms
410‑121‑0021
Organizations Authorized to Provide Pharmaceutical Prescription Services
410‑121‑0030
Practitioner-Managed Prescription Drug Plan
410‑121‑0032
Supplemental Rebate Agreements
410‑121‑0033
Polypharmacy Profiling
410‑121‑0040
Prior Authorization Required for Drugs and Products
410‑121‑0060
How to Get Prior Authorization for Drugs
410‑121‑0061
Durable Medical Equipment, Medical Supplies, and Medical Surgical Services (Physician Administered Drugs)
410‑121‑0100
Drug Use Review
410‑121‑0111
Pharmacy and Therapeutics Committee
410‑121‑0135
Pharmacy Management Program
410‑121‑0143
Client Confidentiality
410‑121‑0145
Prescription Requirements
410‑121‑0146
Dispensing Limitations
410‑121‑0147
Exclusions and Limitations
410‑121‑0148
Dispensing in a Nursing Facility or Community Based Care Living Facility
410‑121‑0150
Billing Requirements
410‑121‑0155
Reimbursement
410‑121‑0157
Participation in the Medicaid Drug Rebate Program
410‑121‑0160
Dispensing Fees
410‑121‑0185
Pharmacy Based Immunization Delivery
410‑121‑0190
Medication Therapy Management Services and Clozapine Therapy Monitoring
410‑121‑0200
Billing Forms
410‑121‑0220
Instructions for Completion of the Prescription Drug Invoice
410‑121‑0280
Billing Quantities, Metric Quantities and Package Sizes
410‑121‑0300
CMS Federal Upper Limits for Drug Payments
410‑121‑0420
DESI Less-Than-Effective Drug List
410‑121‑0580
Oregon Medicaid and Pharmaceutical Manufacturers’ Dispute Resolution Procedures
410‑121‑0625
Items Covered in the All-Inclusive Rate for Nursing Facilities
Last Updated

Jun. 8, 2021

Rule 410-121-0032’s source at or​.us