to have the option of different rebate effective dates. This section states that agreements to the rebate program that have been entered on or after November 29, 1999, may go into effect that day, and states option, any date after up to the first day of the quarter. The Medicaid Drug Rebate Program and Medicaid Managed Care At the time the law was enacted, outpatient prescription drugs covered by Medicaid managed care organizations were excluded from access to the drug rebate program. In 1990, only 2.8 million people were enrolled in Medicaid managed care and so the savings lost by the exemption were relatively small. However, enrollment in Medicaid managed care plans has grown significantly. The Drug Rebate Equalization Act of 2009 (DRE), introduced in the 111th United States Congress by Representative Bart Stupak as H.R. 904, and in the Senate by Senator Jeff Bingaman as S. 547, sought to equalize the treatment of prescription drug discounts between Medicaid managed care and Medicaid fee-for-service. In offering states access to rebates for drugs covered by Medicaid managed care plans, this policy was seen as a way to provide relief for federal and state budgets. The Congressional Budget Office scored the DRE as saving $11 billion over ten years. This proposal was also in President Barack Obama’s 2010 United States federal budget. The DRE passed in both the House and Senate as part of their respective comprehensive health care reform legislation, and was signed into law on March 23, 2010, by President Obama with the Patient Protection and Affordable Care Act. The DRE became effective upon enactment. References Medicare and Medicaid (United States)