Medicaid
The Apexan who is our Medicaid expert.
Who is Michael Peters?
The Apexan who is a presidential trivia expert.
Who is Natalie?
**DAILY APEXAN!**
In the pilot program, covered entities initially purchase drugs at this price and later receive a rebate on verified eligible claims.
What is WAC?
HRSA audits are designed to ensure covered entities comply with key 340B requirements, including prevention of these two major compliance violations.
What are diversion and duplicate discounts?
Abbreviated IRA, this 2022 U.S. law lowers prescription drug costs for Medicare members, making healthcare more affordable through enhanced subsidies for the Affordable Care Act (ACA) marketplace, and caps insulin costs.
What is the Inflation Reduction Act?
**DAILY APEXAN!**
When the manufacturer gives both an upfront 340B discount and a rebate to the State Medicaid agency.
What is a duplicate discount?
The two *proposed* Apexus mascots.
What are sharks and dogs?
The Federal Register notice announcing the HRSA 340B Rebate Pilot specifies that approved pilot plans will go into effect on this date.
What is January 1, 2026?
HRSA requires this type of documentation for referrals to ensure 340B patient definition compliance.
What is closed-loop documentation (outbound referral and inbound consultation notes)?
The number of drugs added in 2026 to the IRA list.
What is 10?
When a manufacturer pays multiple rebates to a covered entity, State Medicaid, and a Pharmacy Benefit Manager.
What are stacked rebates?
The two Apexan bird experts.
Who are Neesha and Kendrick?
***Kendrick Rummel will NOT explain how birds are government spies.***
For the initial pilot, the model is limited to drugs selected under this federal negotiation program.
What is the Medicare Drug Price Negotiation Program (MDPNP)?
**DAILY APEXAN!**
Abbreviated MTM, this type of clinical service, often provided after a prescription is written by an outside provider, has been under greater HRSA scrutiny related to the 340B patient definition.
What is Medication Therapy Management?
Name one of the 2026 selected IRA drugs.
What are Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and NovoLog?
Data listed on OPAIS if you bill Medicaid for 340B drugs.
What are states being billed, NPIs and/or Medicaid Provider Numbers (MPNs)?
The Apexan who can teach you how to *juggle* multiple tasks (or balls).
Who is Chris Clement?
Under pilot plan requirements, all rebates must be paid to the covered entity within this many calendar days of data submission (unless otherwise justified).
What is 10 days?
Abbreviated ADM, HRSA has updated the 2025 data request list to more easily identify these types of models used by covered entities to navigate access issues due to manufacturer contract pharmacy restrictions.
What is Alternate Distribution Model?
**DAILY APEXAN!**
This manufacturer withdrew from the Medicaid Drug Pricing Program (MDRP).
Who is Bausch Health US, LLC?
The quarter in 2017 when the Medicaid Exclusion File (MEF) went digital on OPAIS.
What is Q4 2017?
The Apexans you go to when you want to go deep sea fishing while flying a drone, drinking home-brewed beer with a side of salsa verde.
Who are Gabe, Danish, Michael, and Jennifer?
Manufacturers are required to use only defined claim elements for validation, including these two numbers used for routing prescription claims through pharmacy benefit processors.
What are Bank Identification Number (BIN) and Processor Control Number (PCN)?
The percentage of finalized FY25 audits that had findings related to diversion.
Take your best guess!
What is 9 out of 67 (~13%)?
Updated 9/23/25
Name three out of the 2026 selected IRA drugs.
What are Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and NovoLog?