§ 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.)