Supplemental Drug Rebate
The Centers for Medicare and Medicaid Services (CMS) approved our State Plan Amendment and model Supplemental Rebate Agreement in 2004. Slight modifications to the contract have been approved by CMS for the 2015 contract cycle. We are currently in the process of getting a Medicaid State Plan Amendment approval from CMS regarding plans for calendar year 2023.
Each state is allowed to create their own mechanism to determine supplemental rebate amounts and contract with manufacturers. Through the 2016 calendar year, Oklahoma will not use a rebate vendor. The Oklahoma DUR board will set the tier structure and criteria for a particular drug class and the OHCA may extend an offer to manufacturers to bid their product for inclusion in the Supplemental Rebate program. Once these contracts are received, the OHCA Supplemental Rebate Workgroup will meet and discuss the specifics of each bid. All calculations and contracting functions will be done in house by OHCA staff.
Effective for the 2017 calendar year, all rebate negations/offers will be done through the Sovereign States Drug Consortium (SSDC). The SSDC is a collaborative group of Medicaid States that are focused on providing quality pharmaceutical care while controlling costs. The SSDC will coordinate, collect, and negotiate all rebate offers for OHCA for 2017; including diabetic supplies. The OHCA Supplemental Rebate Workgroup will consider the specifics of the offers and the Oklahoma DUR board will consider the tier structure and set the criteria for each particular drug class. OHCA staff will still be responsible for the contracting process. Please visit the SSDC website at https://rxssdc.org/ for further information about the SSDC.
All Supplemental Rebate bids are confidential and it is not appropriate to discuss rebate offers with any DUR board member or College of Pharmacy staff, or representative of another manufacturer.