Medicaid Drug Rebate Program (MDRP): Quarterly State Invoice (CMS-R-144) and State Agency Contact Form (CMS-368)

OMB 0938-0582

OMB 0938-0582

Section 1927 of the Social Security Act requires each State Medicaid agency to report quarterly prescription drug utilization information to drug manufacturers and to CMS via form CMS-R-144. As part of this information, the State Medicaid agencies are required to report the total Medicaid rebate amount they claim they are owed by each drug manufacturer for each covered prescription drug product each quarter.

The latest form for Medicaid Drug Rebate Program (MDRP): Quarterly State Invoice (CMS-R-144) and State Agency Contact Form (CMS-368) expires 2023-06-30 and can be found here.

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State Agency Contact Form (CMS-368)

Federal Enterprise Architecture: Health - Health Care Services

Form CMS-368State Agency Contact FormFillable PrintableForm

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.


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