§ 42-66.2-10 - Pharmaceutical manufacturer drug rebates.
SECTION 42-66.2-10
§ 42-66.2-10 Pharmaceutical manufacturerdrug rebates. – (a) The director shall enter into prescription drug rebate agreements withindividual pharmaceutical manufacturers under which the department shallreceive a rebate from the pharmaceutical manufacturer equal to the basic rebatesupplied by the manufacturer under 42 U.S.C. § 1396a for every eligibleprescription drug dispensed under the program. Each prescription drug rebateagreement shall provide that the pharmaceutical manufacturer shall makequarterly rebate payments to the department equal to the basic rebate suppliedby the manufacturer under 42 U.S.C. § 1396a for the total number of dosageunits of each form and strength of a prescription drug which the departmentreports as reimbursed to providers of prescription drugs, provided thesepayments shall not be due until thirty (30) days following the manufacturer'sreceipt of utilization data from the department including the number of dosageunits reimbursed to providers of eligible prescription drugs during the quarterfor which payment is due.
(b) Upon receipt of the utilization data from the department,the pharmaceutical manufacturer shall calculate the quarterly payment. Thedepartment may, at its expense, hire a mutually agreed upon independent auditorto verify the calculation and payment. In the event that a discrepancy isdiscovered between the pharmaceutical manufacturer's calculation and theindependent auditor's calculation, the pharmaceutical manufacturer shalljustify its calculations or make payment to the department for any additionalamount due.
(2) The pharmaceutical manufacturer may, at its expense, hirea mutually agreed upon independent auditor to verify the accuracy of theutilization data provided by the department. In the event that a discrepancy isdiscovered, the department shall justify its data or refund any excess paymentto the pharmaceutical manufacturer. The department may, at its expense,establish a grievance adjudication procedure, which provides for independentreview of manufacturer documentation substantiating the basic rebate amount perunit delivered under 42 U.S.C. § 1396a. In the event that a discrepancy isdiscovered, the department shall justify its data or refund any excess paymentto the pharmaceutical manufacturer.
(c) All eligible prescription drugs of a pharmaceuticalmanufacturer that enters into an agreement pursuant to subsection (a) shall beimmediately available and the cost of these eligible drugs shall be reimbursedand not subject to any restrictions or prior authorization requirements. Anyprescription drug of a manufacturer that does not enter into an agreementpursuant to subsection (a) shall not be reimbursable, unless the departmentdetermines the eligible prescription drug is essential to program participants.
(d) All rebates collected by the department from the rebatepayments made for drugs for persons eligible under the provisions of §42-66.2-5(a) shall be deposited in a restricted receipt account, hereby createdwithin the agency and known as Pharmaceutical Rebates, to pay costs inaccordance with the provisions of § 42-66.2-4.