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Medicaid Drug Rebate Program Dispute Resolution

The Medicaid DRP is an alternative dispute resolution process developed and administered by CMS that provides facilitation and mediation assistance to manufacturers and states when Medicaid drug rebate amounts are in dispute.

How does DRP Process Work?

CMS staff developed and implemented the DRP to address the problem of unpaid and disputed drug rebates. CMS Regional Office (RO) and Central Office staff are available to assist states and manufacturers with dispute resolution; however, state-specific dispute issues should first be forwarded to the appropriate Regional Office (RO) DRP coordinator. That RO coordinator may handle the issue independently or, if necessary, consult with Central Office staff for further direction or assistance. See list of Regional Office DRP Coordinators .

In addition, throughout the year, CMS has typically participated and encouraged dispute resolution efforts at industry sponsored forums/symposiums. Even though these dispute resolution meetings are not CMS sponsored, when CMS staff (Central Office and RO) is present, they will be available for facilitation assistance for those manufacturers and states that request their assistance in advance.  

Dispute Resolution Program Best Practices

CMS has compiled a list of best practices for drug manufacturers and a list of best practices for states acquired through our experiences with the Dispute Resolution Program (DRP). Please note that the best practices are intended to be used as a resource for all participants in the program. In addition to providing real-life examples of how best to resolve rebate disputes and how to reduce the incidence of initial disputes, this information also offers valuable insight from the perspective of those most intimately involved in the dispute resolution process.  

These best practices are made possible through the cooperation of states, manufacturers and others who work closely with this program. Both the DRP and the best practices clearly demonstrate the ability of the states and the manufacturers to effectively work together in a partnership. CMS remain committed to helping the states and manufacturers resolve disputes through the DRP and, by working together, to seek new ways to continually improve the Medicaid Drug Rebate Program.  

A sample resolution letter is provided for your convenience.

Disclaimer: Any opinion expressed here does not represent the opinion of the agency and will not bind or obligate the Centers for Medicare & Medicaid Services (CMS).

DRP Issues

Disagreements over rebate payments are a reality in the Medicaid Drug Rebate Program (MDRP).  Section 1927 of the Social Security Act (the Act), the rebate agreement, and various program releases provide some guidance to States and manufacturers on how to resolve such disputes.  In addition, CMS is committed to leading the DRP effort, improving it from the experience we've gained since the start of the rebate program in 1991, and assisting both States and manufacturers by sharing those experiences.  To that end, CMS will be using this site to highlight various dispute-related topics that have occurred over the years, and which may be of interest to both States and manufacturers.

Please note that the information provided here, and any opinions expressed therein, 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 Dispute Resolution Program and do not in any way revise and modify the requirements set forth in Section 1927 of the Act, the rebate agreement, program releases, or regulations.

Please click on the link below for different topics on resolving disputes.

Questions on the DRP?  Email DRP@cms.hhs.gov.