Or. Admin. Code § 410-121-0032

Current through Register Vol. 63, No. 11, November 1, 2024

Section 410-121-0032 - Supplemental Rebate Agreements

(1) The Division of Medical Assistance Programs (Division) has both a, Centers for Medicare and Medicaid Services (CMS) approved Supplemental Rebate Agreement and a (CMS) approved Value based Agreement. These templates and instructions are available on the Oregon Health Authority's (Authority) web site at: www.oregon.gov/OHA/healthplan/pages/pharmacy-policy.aspx

(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 or value base 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 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 shall notify manufacturers of the status of their offer(s).

(c) Supplemental Agreements shall 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.

Or. Admin. Code § 410-121-0032

OMAP 97-2004, f. 12-30-04, cert. ef. 1-1-05; DMAP 16-2008, f. 6-13-08, cert. ef. 7-1-08; DMAP 36-2008, f. 12-11-08, cert. ef. 1-1-09; DMAP 14-2009 f. 6-12-09, cert. ef. 7-1-09; DMAP 39-2009, f. 12-15-09, cert. ef. 1-1-10; DMAP 44-2011, f. 12-21-11, cert. ef. 1-1-12; DMAP 35-2018, minor correction filed 05/25/2018, effective 5/25/2018; DMAP 40-2018, minor correction filed 05/25/2018, effective 5/25/2018; DMAP 96-2023, amend filed 12/22/2023, effective 1/1/2024

Statutory/Other Authority: ORS 414.065, ORS 413.042, ORS 409.025, 409.040 & 409.110

Statutes/Other Implemented: ORS 414.065