PBM5
CMS-Required Outcome
CMS-required outcome
The system supports cost savings by enabling the tracking, monitoring, and reporting of manufacturer's pharmacy drugs and rebate savings.
Default metrics
- Provide a sample of the CMS rebate report and the manufacturer rebate report with production data.
- Provide the post-production operational measure of rebates collection.
Regulatory sources
- Section 1927 of the SSA
- 42 CFR 447.520
- Section 1927(b)(2) of the SSA
- 42 CFR 447.511
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.