Form 8947 - Report Of Branded Prescription Drug Information Page 9
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Form 8947 (Rev. 10-2013)
Page
Medicaid state supplemental rebate amount. Enter the Medicaid
Schedule E. Summary of Form 8947
state supplemental rebates for each NDC paid by the covered entity for
Use Schedule E to report the total number of controlled group
sales under Medicaid in sales year 2012. For this purpose, enter
members, including the designated entity, shown on page 1, Part I, and
Medicaid state supplemental rebates invoiced by states and paid by the
the totals from each of the other schedules attached to this report.
covered entity for drugs in sales year 2012 and paid before you file
Form 8947.
Paperwork Reduction Act Notice. We ask for the information on Form
Latest tax year section 45C orphan drug credit allowed. For the drug
8947 to carry out the Internal Revenue laws of the United States. We
listed, enter the latest tax year that the section 45C orphan drug credit
need it to ensure that you are complying with these laws and to allow us
was allowed. The section 45C credit is considered to be allowed if any
to figure and collect the right amount of fees. You are not required to file
entity claimed the credit even if that entity was not part of the covered
Form 8947. If you do not file Form 8947, we will calculate your branded
entity at the time the credit was claimed. Use the format yyyy. Fiscal
prescription drug fee based on information reported on previously filed
year filers must show the tax year according to the tax year's beginning.
Forms 8947 (if any), NDC information maintained by the FDA, sales and
rebate information reported by the Agencies, and orphan drug
Name of Section 45C orphan drug. Enter the generic or trade name
information maintained by the IRS.
shown on FDA Form 3671, if applicable.
You are not required to provide the information requested on a form
Date of FDA approval for non-orphan drug marketing. Enter the date
that is subject to the Paperwork Reduction Act unless the form displays
of FDA approval for non-orphan drug marketing, if applicable. Use the
a valid OMB control number. Books or records relating to a form or its
format mmddyyyy.
instructions must be retained as long as their contents may become
Schedule B. Branded Prescription Drug Information
material in the administration of any Internal Revenue law. Generally,
NDC Additions and Deletions
the information you report on this form is confidential, as required by
section 6103.
If you filed Form 8947 for sales year 2011, use Schedule B (check Item
The time needed to complete and file Form 8947 will vary depending
A, box 2) to report the following for sales year 2012.
on individual circumstances. The estimated average time is:
• NDCs that you did not report on your Form 8947 for sales year 2011
Recordkeeping
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. 7 hrs., 24 min.
(additions), and
Preparing, copying, assembling,
• NDCs that are no longer in the covered entity (deletions). An NDC is no
and sending the form
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. 51 min.
longer in the covered entity if you reported it on your Form 8947 for
Learning about the law or the form .
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.
.
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.
. 42 min.
sales year 2011 and it ceases to be described in the definition of
branded prescription drugs for the covered entity's 2012 sales year
If you have comments concerning the accuracy of these time
(see Branded Prescription Drugs under Definitions above).
estimates or suggestions for making Form 8947 simpler, we would be
happy to hear from you. You can send your comments to:
Do not report the movement of NDCs between members of the
controlled group.
Internal Revenue Service
Tax Forms and Publications Division
Schedule C. Branded Prescription Drug Information
1111 Constitution Ave. NW, IR-6526
Orphan Drug Changes—Previously Reported NDCs
Washington, DC 20224
If you filed Form 8947 for sales year 2011, use Schedule C (check Item
Do not send Form 8947 to this address. Instead, see Where To File on
A, box 2) to report changes in orphan drug information for previously
page 6.
reported NDCs. Do not include NDCs or orphan drug information
reported on the Schedule B attached to this report.
Schedule D. Branded Prescription Drug Medicaid
State Supplemental Rebates— Previously Reported
NDCs
If you filed Form 8947 for sales year 2011, use Schedule D (check Item
A, box 2 or box 3, as applicable) to report Medicaid state supplemental
rebates paid by the covered entity for sales under Medicaid occurring in
sales year 2012. Enter rebates only for NDCs which you reported when
you filed Form 8947 for sales year 2011. For this purpose, enter
Medicaid state supplemental rebates invoiced by states and paid by the
covered entity for drugs in sales year 2012 and paid before you file Form
8947. Do not include NDCs or rebate information reported on the
Schedule B attached to this report.
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