Follow-Up Audit of the Medicaid Drug Rebate Program in Idaho

In a follow-up audit of Idaho's Medicaid drug rebate program, we found that the State had implemented the recommendations from our prior audit that related to its policies and procedures, segregation of duties, and dispute resolution.  We also found that the State had established controls over collecting rebates on single-source drugs administered by physicians.  Manufacturers may make their outpatient drugs eligible for Federal Medicaid funding by entering into a rebate agreement with the Centers for Medicare & Medicaid Services and paying quarterly rebates to the States. 

Although the State did not implement the recommendation related to the accounts receivable system, it demonstrated that it maintained a subsidiary accounts receivable system at a sufficiently detailed level.  In addition, the State did not implement the recommendation related to quarterly reporting and did not fully implement the recommendation related to management oversight for adjustments, dismissals, and writeoffs.

We recommended that the State implement internal controls to maintain sufficient documentation to support the amounts reported on Form CMS‑64.9R and provide management oversight for adjustments and dismissals of drug rebate funds.  The State concurred with our recommendations.