Policy framework: OBRA 1990 & 1993
Medicaid Best Price Provision: Rebates from industry
Possibility for prior authorisation
Rebates: single source drugs
- Total number of units sold of a specific dosage form & strength
- The greater of: (i) the difference between AMP and the best price for the above or (ii) the minimum rebate % of such AMP for the above period (15.1%)
- (Minimum) Rebate = AMP – 15.1%
Rebates: multiple source drugs
- Total number of units sold of a specific dosage
- The applicable % of AMP (11%) for the dosage form & strength for the rebate period
- (Fixed) Rebate = AMP – 11%