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Wyoming Claimed Unallowable Federal Reimbursement for Some Medicaid Physician-Administered Drugs

The Wyoming Department of Health, Division of Healthcare Financing (State agency), did not always comply with Federal Medicaid requirements for invoicing manufacturers for rebates for physician-administered drugs. The State agency did not invoice manufacturers for rebates associated with $2.6 million ($1.3 million Federal share) in physician-administered drugs. Of this amount, $2.3 million ($1.2 million Federal share) was for single-source drugs, and $286,000 ($143,000 Federal share) was for top-20 multiple-source drugs. Because the State agency's internal controls did not always ensure that it invoiced manufacturers to secure rebates, the State agency improperly claimed Federal reimbursement for these single-source drugs and top-20 multiple-source drugs.

Further, the State agency did not submit the utilization data necessary to secure rebates for all other physician-administered drugs. Although the State agency generally collected the drug utilization data necessary to invoice the manufacturers for rebates associated with these claims, providers submitted claims totaling $185,000 ($93,000 Federal share) that did not have national drug codes (NDCs). We were unable to determine whether the State agency was required to invoice for rebates for these other physician-administered drug claims that did not have NDCs in the utilization data. Furthermore, under the Medicaid drug rebate program, claims totaling $439,000 ($219,000 Federal share), which contained NDCs, could have been eligible for rebates.

Filed under: Center for Medicare and Medicaid Services