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{"sheet":"Contents","index":0,"n_rows":10,"n_cols":2,"rows_kept":10,"cut":false,"hidden":false,"merged":[]}
["Prescription Drug Rebates"]
["Data Submission: for Prescription drugs with dates of fill in 2022, 2023, and 2024."]
["Due Date: September 10, 2025"]
["Data Specification Manual "]
[]
["This workbook contains the following tabs:"]
["Tab Name","Contents"]
["A. Front Page","Payer Data Entry: Overview of File and Data Verification"]
["B. Rebate Data ","Payer Data Entry: Rebate Data"]
["C. PBM Contract Data","Payer Data Entry: Pharmacy Benefit Manager (PBM) Contract Data"]

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["Prescription Drug Rebates"]
["A. File Overview and Payer Verification"]
[]
[]
[null,"I verify that the information in this workbook is accurate."]
["Contact Name:",null,"[Input Required]"]
["Contact Email:",null,"[Input Required]"]
[]
[null,"Table A.1: File Overview",null,"[Input Required]"]
[null,"Payer Name   *"]
[null,"Payer OrgID  "]
[null,"Submission Year  *"]
[null,"Final Data: Reporting Year  "]
[null,"Final Data: Claims Paid Through Date  "]
[]
[null,"Table A.2: Additional Data Confirmation                                                                                                                                                                                                                                "]
[null,"Is the data limited only to members  for whom the payer is the primary payer?"]
[null,"Please confirm whether you have point of sale rebates (Y or N)"]
[null,"Rebate Data File Comments "]
[null,"PBM Contract Data Comments"]
[]
[]
[null,"Table A.3: Point of Sale Rebates (ONLY COMPLETE IF YOU HAVE POINT OF SALE REBATES)"]
[null,"If you have point of sale rebates, please specify years, populations, and plan offerings that have these point of sale rebates:"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,"Please confirm that reported Prescription Drug rebate amounts include point of sale rebates (Y or N)"]
[]
[null,"Please confirm that gross pharmacy expenditures are \"grossed up\" for pharmacy rebates (including point of sale rebates) and Medicare coverage gap discounts. (Y or N)"]
[]
[null,"Please explain your methodology for how you \"gross up\" pharmacy expenditures for point of sale rebates:"]

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["Prescription Drug Rebate Data Filing"]
["For prescription drugs with dates of fill in 2022, 2023, and 2024."]
[]
["DR001","DR002","DR003","DR004","DR005","DR006","DR007","DR008","DR009","DR010","DR011","DR012","DR013","DR014","DR015","DR016","DR017","DR018","DR019","DR020","DR021","DR022","DR023"]
["Payer Org ID","Payer Name","Insurance Category","Calendar Year","Member Population \n(Enter \"Massachusetts residents\" unless otherwise approved by CHIA)","Member Months (Pharmacy Benefit)","Gross Pharmacy Expenditure Amount: Total","Gross Pharmacy Expenditure Amount: Specialty Drugs","Gross Pharmacy Expenditure Amount: Non-Specialty Brand Drugs","Gross Pharmacy Expenditure Amount: Non-Specialty Generic Drugs","Prescription Drug Rebate Amount: Total","Prescription Drug Rebate Amount: Specialty Drugs","Prescription Drug Rebate Amount: Non-Specialty Brand Drugs","Prescription Drug Rebate Amount: Non-Specialty Generic Drugs","Coverage Gap Discounts (Medicare Only)","Total Net Pharmacy Expenditures (Member & Insurer Pharmacy Liability)","Per Member Per Month Net Pharmacy Expenditure Amount (Insurer & Member Liability)","Per Member Per Month Prescription Drug Rebate Amount ","Allocation Methodology","Comments","Total Pharmacy Expenditure Amount Data Check","Member Months (Medical Benefit)","Gross Pharmacy Expenditure Amount (Medical Benefit): Total"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," = DR007-DR011-DR015"," = DR016 / DR006"," = DR011 / DR006",null,null,"DR008+DR009+DR010-DR007"]
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["Prescription Drug Rebate Data Filing"]
["For prescription drugs with dates of fill in 2022, 2023, and 2024."]
[]
["PBM001","PBM002","PBM003","PBM004","PBM005","PBM006","PBM007","PBM008","PBM009"]
["Payer Org ID","Payer Name","Pharmacy Benefit Manager Name","Insurance Category","Calendar Year","Claims Processing?\n(Enter \"All\", \"Some\", or \"None\")","Drug Formulary Management?\n(Enter \"All\", \"Some\", or \"None\")","Manufacturer Drug Rebate Contracting?\n(Enter \"All\", \"Some\", or \"None\")","Comments"]

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["Id","Name","ShortName","Id",null,"Response Options","Insurance Category"]
[null,"Select Payer:",null,null,null,null,"Commercial"]
[290,"Aetna Health Inc.","Aetna",290,null,null,"Medicare Advantage"]
[291,"Blue Cross Blue Shield of Massachusetts","BCBSMA",291,null,null,"Standalone Medicare Prescription Drug Plan"]
[11226,"WellSense","WellSense",11226,null,null,"Medicaid"]
["00001","CHIA","CHIA","00001",null,null,"SCO"]
[11726,"CIGNA - EAST ","Cigna-East",11726,null,null,"One Care"]
[11474,"CIGNA - WEST ","Cigna-West",11474,null,null,"PACE"]
[10728,"Commonwealth Care Alliance","CCA",10728,null,null,"Other"]
[8026,"Fallon Community Health Plan","Fallon",8026]
[300,"Harvard Pilgrim Health Care","HPHC",300]
[302,"Health Plans Inc.","HPI",302]
[301,"Health New England","HNE",301]
[3735,"Mass General Brigham Health Plan","MGBHP",3735]
[11227,"Tufts Public Plans ","THPP",11227]
[308,"Tufts Health Plan","THP",308]
[12103,"Tufts Medicare Advantage","Tufts Med Adv",12103]
[310,"UniCare Life and Health Insurance Company","UniCare",310]
[312,"United Healthcare Insurance Company","United ",312]
[10926,"United Medicare Advantage","United Med Adv",10926]
[12814,"United Senior Care Options (SCO)","United SCO",12814]
[3156,"MassHealth ","MassHealth",3156]

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