Form 8947 - Report Of Branded Prescription Drug Information Page 7
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Form 8947 (Rev. 10-2012)
Page
Section references are to the Internal Revenue Code unless otherwise
For more information, see Definitions and Item B. Covered Entity
noted.
Information below. Also, see Temporary Regulations sections 51.1T
through 51.12T, and section 51.6302-1T.
Future developments. For the latest information about developments
related to Form 8947 and its instructions, such as legislation enacted
Who Files
after they were published, go to
Generally, each manufacturer or importer of branded prescription drugs
What's New
with sales to specified government programs (or sales due to coverage
under the programs) may submit Form 8947. Each entity that is treated
If you want to designate your employee to discuss your report with the
as a single covered entity is requested to file one Form 8947, providing
IRS, check the "Yes" box on page 6, under Alternate Contact Person
all requested information for each such manufacturing and reporting
Designee. Also, enter the designee's name, title, and phone number.
entity, as described in these instructions.
If you check the "Yes" box, you are authorizing the IRS to call the
Schedules A, B, C, D, and E. All filers must complete page 1 and page
designee to answer any questions that may arise and the designee to
6, which includes Schedule E, Summary of Form 8947, and Part II,
call the IRS with any questions related to the administration of the 2013
Signature of Official Signing On Behalf of the Covered Entity (Single-
branded prescription drug fee year. You are also authorizing the
Member, Common Parent of an Affiliated Group, or Other Designated
designee to:
Entity) and Consent by the Common Parent or Designated Entity (if
applicable).
• Receive copies of IRS letters upon request,
First time filers must also attach Schedule A, Branded Prescription
• Respond to IRS letters, and
Drug Information—First Time Filers Only.
• Receive and provide information regarding the status of a payment
Subsequent year filers with changes to report must attach Schedule
or an amount due back to you.
B, Branded Prescription Drug Information NDC Additions and Deletions,
General Instructions
or Schedule C, Branded Prescription Drug Information Orphan Drug
Changes—Previously Reported NDCs, or both.
Purpose of Form
Subsequent year filers reporting Medicaid state supplemental rebates
for sales year 2011 drug sales must attach Schedule D, Branded
Use Form 8947 to report the following information for branded
Prescription Drug Medicaid State Supplemental Rebates—Previously
prescription drugs sold by covered entities to specified government
Reported NDCs, to report NDCs and their Medicaid state supplemental
programs (or sales due to coverage under the programs) during sales
rebates. See Completing Pages 1 and 6, and the Correct Schedule(s)
year 2011.
below.
• National Drug Codes (NDCs).
When To File
• Medicaid state supplemental rebate information.
File Form 8947 by December 17, 2012, to report sales year 2011
• Section 45C orphan drug information.
information.
• Designated entity and controlled group members information, if
applicable.
Definitions
The IRS will use the information you submit on Form 8947 to calculate
For the definitions of covered entity, single-person covered entity, and
the annual fee for branded prescription drug sales ("the fee"). The fee is
designated entity, see Item B. Covered Entity Information under Specific
imposed by section 9008 of Public Law 111-148 (Patient Protection and
Instructions.
Affordable Care Act), as amended by Public Law 111-152 (Health Care
and Education Reconciliation Act of 2010) (the “Act”).
Completing Pages 1 and 6, and the Correct Schedule(s)
First time filer
Subsequent year filer with
Subsequent year filer with no
Subsequent year filer with no
(check Item A, box 1)
changes
changes, reporting rebates
changes, not reporting rebates
(check Item A, box 2)
(check Item A, box 3)
(check Item A, box 4)
Page 1
Yes
Yes
Yes
Yes
Schedule A
Yes
No
No
No
Yes, if NDC additions or
Schedule B
No
deletions (1), (2), (3)
No
No
Schedule C
No
Yes, if orphan drug changes (1), (3)
No
No
Schedule D
No
Yes, if reporting rebates (1), (3)
Yes
No
Schedule E
Yes, if Item B, box 2a or 2b,
Yes, if Item B, box 2a or 2b,
Yes, if Item B, box 2a or 2b,
Yes, if Item B, box 2a or 2b,
Schedule E, Line 1
checked
checked
checked
checked
Schedule E, Line 2
Yes
No
No
No
Schedule E, Line 3
Yes
No
No
No
Schedule E, Line 4
No
Yes, if Schedule B attached
No
No
Schedule E, Line 5
No
Yes, if Schedule B attached
No
No
Schedule E, Line 6
No
Yes, if Schedule B attached
No
No
Schedule E, Line 7
No
Yes, if Schedule C attached
No
No
Schedule E, Line 8
No
Yes, if Schedule D attached
Yes
No
Schedule E, Line 9
No
Yes, if Schedule D attached
Yes
No
Part II
Yes
Yes
Yes
Yes
(1) NDCs reported on Schedule B cannot be shown on Schedules C or D.
(2) On Schedule B, Section I, report as additions only NDCs that were not associated with the covered entity for the previous sales year.
(3) On Schedule B, Section II: Schedule C; or Schedule D, report only NDCs that were associated with the covered entity for the previous sales year.
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