A Single Solution to the Top Medicaid Rebate Challenges

In an effort to contain growing healthcare costs, Congress enacted the Omnibus Budget Reconciliation Act of 1990 (OBRA’90) and created the Medicaid Drug Rebate Program. Pharmaceutical manufacturers’ participation in the program became a prerequisite for Medicaid coverage of outpatient prescription drugs. Since then, states have been required to collect associated drug rebates to receive federal funding for either state administered fee for service plans or plans administered by Medicaid managed care organizations.

While the Medicaid Drug Rebate Program was developed to generate savings, realizing the full potential of these discounts by medical pharmacy plans has proven to be particularly challenging. However, after utilizing RJ Health Systems’ data, one state Medicaid program increased rebate savings from 40% of the reimbursed amount to 50% since their 2014 baseline. The NDC Medicaid Rebate Dataset was designed to help you increase rebate savings as well!

Top Medicaid Rebate Challenges that the RJHS Medicaid Rebate Dataset Addresses

Correctly identifying Medicaid Rebate eligible drugs at the NDC level
The RJHS Medicaid Rebate Dataset includes a comprehensive list of rebate eligible (and ineligible) NDCs by HCPCS code.

Maintaining or accessing an up to date and accurate HCPCS to NDC crosswalk
The RJHS Medicaid Rebate Dataset is continuously updated and includes HCPCS to NDC cross-walked data so that appropriate codes can be billed and validated
The RJHS Medicaid Rebate Dataset contains 2.5 times as many cross-walked rebate eligible NDCs than a popular free download.

Accurately converting HCPCS Units to NDC Units to avoid under/over-invoicing
The RJHS Medicaid Rebate Dataset provides HCPCS to NDC unit conversions so that proper units can be invoiced.

Properly submitting Medicaid Rebate invoices to reduce disputes with Pharma Manufacturers
The RJHS Medicaid Rebate Dataset simplifies the rebate submission process by combining the data required for the accurate completion of rebate invoices
into a comprehensive product.

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