Federal Reports

Washington did not fully comply with Federal Medicaid requirements for billing manufacturers for rebates for drugs dispensed to enrollees of Medicaid managed-care organizations. Washington properly billed manufacturers for some rebates for pharmacy and physician-administered drugs. However, it did not bill for and collect from manufacturers rebates of $34.1 million ($17 million Federal share). For drugs that were eligible for rebates, Washington did not bill for rebates of $14.2 million (Federal share) for pharmacy drugs and $2.4 million (Federal share) for single-source and top-20 multiple-source physician-administered drugs. For drugs that may have been eligible for rebates, Washington did not bill for rebates of $395,746 (Federal share) for non-top-20 multiple source physician-administered drugs with National Drug Codes. In addition, Washington did not bill for rebates for 17,140 claim lines for other physician-administered drugs. Because there was insufficient information to determine the amount of any rebates that may have been due, we set aside these claim lines for resolution by the Centers for Medicare & Medicaid Services (CMS).

To see our report, click on the link below

Please see the link below for a video and podcast discussing the results of this review.