Covered entities/contracted pharmacies:
- Correctly reporting claims filled with 340B stock for 340B-eligible patients to ensure rebates are not collected for these drugs
- Working with the drug manufacturer to resolve disputes when either traditional or managed care claims are not indicated appropriately with SCC “20” or “U8” modifiers and HHSC invoices for rebates MCOs and pharmacy benefit managers:
- Maintain shared-savings model
- Passing the submission clarification code “20” or “U8” modifier in encounter data to HHSC
- It is not their responsibility to oversee covered entities or the contracted pharmacy to ensure rebates are not collected.
HHSC does not approve alternative arrangements for preventing duplicate discounts. The automated drug rebate system relies on the submitted code or modifier to identify claims excluded from the rebate invoicing process.