Get the free 2024 Supplemental Rebate Agreement

This document outlines the terms and conditions of a supplemental rebate agreement between the Oregon Health Authority and a pharmaceutical manufacturer for the benefit of Medicaid recipients. It details the obligations of both parties, including the payment and calculation of rebates, compliance requirements, and provisions for record-keeping and confidentiality.

How to fill out 2024 supplemental rebate agreement

How to fill out 2024 supplemental rebate agreement

1. Obtain the 2024 Supplemental Rebate Agreement form from the appropriate website or office.
2. Review the instructions carefully before filling out the form.
3. Enter your contact information in the designated fields at the top of the form.
4. Provide information regarding your eligibility for the supplemental rebate program, including any necessary documentation.
5. Fill in the requested financial information accurately to reflect your current financial situation.
6. Sign and date the agreement at the bottom of the form to certify the information provided.
7. Submit the completed form by the specified deadline to the appropriate agency.

Who needs 2024 supplemental rebate agreement?

1. Individuals or families with low to moderate income who are eligible for additional financial support.
2. Applicants seeking financial assistance for healthcare costs or prescription medications.
3. Those enrolled in specific state or federal assistance programs requiring a supplementary agreement.

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What is supplemental rebate agreement?

A supplemental rebate agreement is a contract between a pharmaceutical manufacturer and a state Medicaid program, wherein the manufacturer agrees to provide rebates above those required under federal law in exchange for the Medicaid program's inclusion of their drugs on its preferred drug list.

Who is required to file supplemental rebate agreement?

Pharmaceutical manufacturers that wish to participate in state Medicaid programs must file supplemental rebate agreements.

How to fill out supplemental rebate agreement?

To fill out a supplemental rebate agreement, manufacturers typically must provide information on the drug products, pricing agreements, and rebate terms, ensuring to follow the specific guidelines set by the state Medicaid program.

What is the purpose of supplemental rebate agreement?

The purpose of a supplemental rebate agreement is to secure additional rebates for the state Medicaid program, thereby reducing drug costs and ensuring that patients have access to necessary medications.

What information must be reported on supplemental rebate agreement?

Information that must be reported includes drug product identification, proposed rebate amounts, and any conditions or stipulations associated with the rebate.