Medicaid Drug Rebate Program
E637326
The Medicaid Drug Rebate Program is a U.S. federal initiative that requires drug manufacturers to provide rebates to state Medicaid programs in exchange for Medicaid coverage of their outpatient prescription drugs, helping control costs for the program.
Statements (48)
| Predicate | Object |
|---|---|
| instanceOf |
U.S. federal program
ⓘ
drug rebate program ⓘ |
| administeredBy |
Centers for Medicare & Medicaid Services
NERFINISHED
ⓘ
U.S. Department of Health and Human Services NERFINISHED ⓘ |
| agreementType | national rebate agreement ⓘ |
| appliesTo |
brand-name drugs
ⓘ
generic drugs ⓘ outpatient prescription drugs ⓘ state Medicaid programs ⓘ |
| associatedWithForm |
CMS-64
NERFINISHED
ⓘ
CMS-R-144 NERFINISHED ⓘ |
| benefits |
federal Medicaid program
ⓘ
state Medicaid agencies ⓘ |
| complianceRequirement |
manufacturers must pay quarterly rebates
ⓘ
manufacturers must report pricing data to CMS ⓘ |
| conditionFor | Medicaid coverage of manufacturers’ outpatient drugs ⓘ |
| country |
United States of America
ⓘ
surface form:
United States
|
| covers |
innovator multiple-source drugs
ⓘ
non-innovator multiple-source drugs ⓘ single-source drugs ⓘ |
| dataReportedBy | participating drug manufacturers ⓘ |
| establishedBy | Omnibus Budget Reconciliation Act of 1990 NERFINISHED ⓘ |
| excludes | most inpatient hospital drugs ⓘ |
| frequencyOfRebates | quarterly ⓘ |
| fundingFlow | manufacturers pay rebates to states ⓘ |
| fundingFlow | states share rebate information with CMS ⓘ |
| impact | reduces net cost of covered outpatient drugs for Medicaid ⓘ |
| legalBasis | Social Security Act Section 1927 NERFINISHED ⓘ |
| monitoredBy | CMS Medicaid and CHIP Operations Group NERFINISHED ⓘ |
| policyTool | pharmaceutical pricing regulation mechanism ⓘ |
| purpose |
to ensure Medicaid receives best price rebates from manufacturers
ⓘ
to reduce Medicaid prescription drug costs ⓘ |
| rebateType |
additional inflation-based rebate
ⓘ
basic rebate ⓘ |
| relatedTo |
340B Drug Pricing Program
NERFINISHED
ⓘ
Medicaid Drug Utilization Review Program NERFINISHED ⓘ Medicaid prescription drug benefit NERFINISHED ⓘ Medicare Part D drug coverage NERFINISHED ⓘ |
| requires |
drug manufacturers to pay rebates to state Medicaid programs
ⓘ
states to submit utilization data to manufacturers ⓘ |
| requiresAgreementWith | drug manufacturers ⓘ |
| scope | outpatient drugs only ⓘ |
| startDate | 1991 ⓘ |
| supports | Medicaid drug cost containment ⓘ |
| targetPopulation | Medicaid beneficiaries using outpatient prescription drugs ⓘ |
| usesDataFrom |
Average Manufacturer Price
ⓘ
Best Price ⓘ National Drug Code NERFINISHED ⓘ |
Referenced by (1)
Full triples — surface form annotated when it differs from this entity's canonical label.