TX HHS Form 1402. Value-Based Agreement Concept

The TX HHS Form 1402, Value-Based Agreement Concept, is a crucial document for vendors seeking to establish a value-based agreement with the Texas Health and Human Services Commission (HHSC). This form serves as a conceptual framework for new or existing drugs/products, requiring requestors to provide supporting clinical trial data, publications, and other evidence-based clinical practices.

The purpose of this form is to facilitate review and consideration of value-based agreements by HHSC. To ensure a successful submission, vendors must include all required information, such as the treatment regimen, FDA approval status, CMS rebate eligibility, alternative treatment options, and patient populations covered. The form also requires requestors to provide contact information, date submitted, and their role in submitting the concept.

This Value-Based Agreement Concept form is designed for use by vendors seeking to work with HHSC on a value-based agreement. As the issuing agency, Texas Health and Human Services (HHS) has developed this form to streamline the submission process and ensure that all necessary information is provided. By following the guidelines outlined in this form, vendors can effectively demonstrate the value of their drugs/products and increase the likelihood of a successful agreement with HHSC.