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Report File
Date Issued
Submitting OIG
Office of Personnel Management OIG
Other Participating OIGs
Office of Personnel Management OIG
Agencies Reviewed/Investigated
Office of Personnel Management
Components
Federal Employees Health Benefits Program
Report Number
1H-07-00-19-017
Report Type
Audit
Location

Scottsdale, AZ
United States

Number of Recommendations
8
External Entity
CareFirst BlueChoice as administered by CVS Caremark

Open Recommendations

This report has 3 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
2 No $834,425 $0

We recommend that the PBM return $834,425 to the Carrier (to be credited to the FEHBP) for failing to provide pass-through pricing to the FEHBP at the full value of the PBM’s negotiated discounts with Walgreens and Rite Aid retail pharmacy claims for CYs 2014 through 2016.

3 No $0 $0

We recommend that the PBM continue researching this issue and identify all other pharmacies whose full value of the negotiated discounts were not passed through to the FEHBP.

4 No $0 $0

We recommend that the Carrier require the PBM to pay FEHBP pharmacy claims based on the full value of the PBM’s negotiated discounts with retail pharmacies at the time of adjudication. The guarantee found in the Agreement (between the Carrier and the PBM) should only be applied as a true-up when that guaranteed discount exceeds the pass-through transparent pricing for the period being analyzed.

Office of Personnel Management OIG

United States