TITLE 42

State Affairs and Government

CHAPTER 42-66.2

Pharmaceutical Assistance to the Elderly Act

SECTION 42-66.2-10



   § 42-66.2-10  Pharmaceutical manufacturer

drug rebates. –

(a) The director shall enter into prescription drug rebate agreements with

individual pharmaceutical manufacturers under which the department shall

receive a rebate from the pharmaceutical manufacturer equal to the basic rebate

supplied by the manufacturer under 42 U.S.C. § 1396a for every eligible

prescription drug dispensed under the program. Each prescription drug rebate

agreement shall provide that the pharmaceutical manufacturer shall make

quarterly rebate payments to the department equal to the basic rebate supplied

by the manufacturer under 42 U.S.C. § 1396a for the total number of dosage

units of each form and strength of a prescription drug which the department

reports as reimbursed to providers of prescription drugs, provided these

payments shall not be due until thirty (30) days following the manufacturer's

receipt of utilization data from the department including the number of dosage

units reimbursed to providers of eligible prescription drugs during the quarter

for which payment is due.



   (b)(1) Upon receipt of the utilization data from the

department, the pharmaceutical manufacturer shall calculate the quarterly

payment. The department may, at its expense, hire a mutually agreed upon

independent auditor to verify the calculation and payment. In the event that a

discrepancy is discovered between the pharmaceutical manufacturer's calculation

and the independent auditor's calculation, the pharmaceutical manufacturer

shall justify its calculations or make payment to the department for any

additional amount due.



   (2) The pharmaceutical manufacturer may, at its expense, hire

a mutually agreed upon independent auditor to verify the accuracy of the

utilization data provided by the department. In the event that a discrepancy is

discovered, the department shall justify its data or refund any excess payment

to the pharmaceutical manufacturer. The department may, at its expense,

establish a grievance adjudication procedure, which provides for independent

review of manufacturer documentation substantiating the basic rebate amount per

unit delivered under 42 U.S.C. § 1396a. In the event that a discrepancy is

discovered, the department shall justify its data or refund any excess payment

to the pharmaceutical manufacturer.



   (c) All eligible prescription drugs of a pharmaceutical

manufacturer that enters into an agreement pursuant to subsection (a) shall be

immediately available and the cost of these eligible drugs shall be reimbursed

and not subject to any restrictions or prior authorization requirements. Any

prescription drug of a manufacturer that does not enter into an agreement

pursuant to subsection (a) shall not be reimbursable, unless the department

determines the eligible prescription drug is essential to program participants.



   (d) All rebates collected by the department from the rebate

payments made for drugs for persons eligible under the provisions of §

42-66.2-5(a) shall be deposited in a restricted receipt account, hereby created

within the agency and known as Pharmaceutical Rebates, to pay costs in

accordance with the provisions of § 42-66.2-4.



History of Section.

(P.L. 1992, ch. 15, art. 8, § 3; P.L. 1992, ch. 133, art. 52, § 1;

P.L. 1995, ch. 370, art. 40, § 141; P.L. 2002, ch. 65, art. 37, § 1;

P.L. 2005, ch. 117, art. 22, § 1.)