Medicaid Drug Rebate Program Dispute Resolution
What is Medicaid Drug Rebate Dispute Resolution?
The national rebate agreement provides an alternative dispute resolution process to the state hearing mechanism for manufacturers and states that disagree on the number of rebate units billed each rebate period. Either party may opt to use the state hearing process at any time, however, both parties must agree to engage in order to use the Medicaid Drug Rebate Dispute Resolution process. States and/or manufacturers that find themselves at an impasse in the process, or that desire or have differing interpretations of Centers for Medicare & Medicaid Services (CMS) program guidance may request assistance from CMS’s Medicaid Dispute Resolution Program (DRP) Team. Questions on the DRP email DRP@cms.hhs.gov.
- Status of Prescription Numbers under the Health Insurance Portability & Accountability Act (HIPAA) Privacy Rule
- Federal Policy Guidance on HCPCS J-Codes Billing
- Suggestions for Resolving Aged Disputes
How do States & Manufacturers Engage CMS in the DRP Process?
State-specific disputes are directed to Regional Office (RO) DRP coordinators, who may handle issues independently, or may work with the Central Office (CO) DRP staff. See list of Regional Office DRP Coordinators. When emailing the RO DRP Coordinator, copy the CO DRP Team at firstname.lastname@example.org.
For non-state-specific DRP guidance, please email the CO DRP Team, who will share any relevant information with the RO DRP Team. Examples of such issues are: 1) interpretation of CMS guidance, and, 2) unit of measure (UOM) issues causing widespread rebate billing errors and/or that may need a conversion factor applied.
DRP Hot Topics/Best Practices
The DRP team will share the latest hot topics and best practices at "DRP Hot Topics/Best Practices". CMS intends to update these frequently, and also invite those responsible for resolving disputes for states and manufacturers to join our DRP listserv. CMS will send notifications of additions or changes to dispute-related topics.
Note: This listserv is solely intended for partners actively working in dispute prevention and resolution in the Medicaid Drug Rebate Program (MDRP). It is not offered as a resource for general MDRP guidance, nor will CMS respond to such inquiries in response to emails generated from this listserv.
For information on the MDRP, please refer to the resources found here “Medicaid Pharmacy email resources”.
Please note that the information provided on this web page does not represent the position of the agency, and will not bind or obligate CMS. The statements included on this web page are intended to provide information on the DRP and do not in any way revise or modify the requirements set forth in Section 1927 of the Act, the rebate agreement, program releases, or regulations.
Page last updated on June 12, 2017