P-15.7. Responsibilities

Covered entities and contracted pharmacies are responsible for the following:

  • Correctly reporting claims filled with 340B purchased drugs for 340B-eligible clients to ensure CMS does not collect rebates for these drugs
  • Cooperating with drug manufacturers to resolve disputes when either traditional or managed care claims are not labeled appropriately with SCC 20 or U8 modifiers and HHSC invoices for rebates MCOs and pharmacy benefit managers
  • Retaining all necessary data, including the submission clarification code 20 or U8 modifier in the encounter data sent to HHSC
  • Maintaining their shared-savings model

It is not the responsibility of the MCO to oversee covered entities or for the contracted pharmacies to ensure HHSC does not collect rebates. If the appropriate values are submitted, then it is the responsibility of the MCO to transmit those fields from the covered entities or pharmacy.

The HHSC drug rebate system relies on the correctly submitted values to identify claims excluded from the rebate invoicing process. HHSC does not approve alternative arrangements for preventing duplicate discounts.