PBM3
CMS-Required Outcome
CMS-required outcome
The system captures the necessary data to ensure timely processing of manufacturer rebates as well as the capability to track rebates to promote beneficiary cost savings.
Default metrics
- The system has the capability to accept/store/apply the rebate and covered outpatient drug (COD) information received from CMS and manufacturers necessary to generate rebate invoices.
- Timely identification of eligible PAD claims/encounters that do not convert to NDC units.
Regulatory sources
- Section 1927 of the SSA
- 42 CFR 447.509
How states write outcomes in this module
OHTo support the implementation of a more efficient and cost effectivfe operating model to deliver pharmacy benefits to Ohio Medicaid members.
The Single Pharmacy Benefit Manager (SPBM) module will provide accurate and timely processing of pharmacy claims utilizing fully transparent pricing and payment methodologies as determined by the Ohio Department of Medicaid.
OHTo support the implementation of a more efficient and cost effectivfe operating model to deliver pharmacy benefits to Ohio Medicaid members.
The Single Pharmacy Benefit Manager (SPBM) module will improve the accuracy and timeliness of the acquisitions and integration of pharmacy claims encounter data.
OHTo support the implementation of a more efficient and cost effectivfe operating model to deliver pharmacy benefits to Ohio Medicaid members.
The Single Pharmacy Benefit Manager (SPBM) module will reduce the overall benefits and administrative costs of the Ohio Medicaid pharmacy program.