Pharmacy Benefit Medicaid Drug Rebate Program Reminder
Governance of which pharmacy drugs may be billed under Neighborhood Health Plan of Rhode Island's Medicaid benefit; affects retail pharmacies and prescribing providers for Medicaid members (not applicable to Commercial or INTEGRITY MedicareMedicaid plans).
No material clinical or coverage changes in this revision.
Medicaid Rebate Billing Eligibility
Medicaid rebate participation billing criteria
Covered when ALL of the following are met:
ALL of the following
- Neighborhood will reject retail pharmacy claims for medications produced by manufacturers who have not entered into a DHHS drug rebate agreement.
- If the prescribed product is a brand-name medication, the prescriber should identify and prescribe a comparable alternative from a manufacturer participating in the rebate agreement.
- If the prescribed product is a generic medication, the dispensing pharmacy must reprocess the claim using the same generic product from a manufacturer that participates in the rebate agreement.
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