Nationwide Audit of Six Ulcer Treatment Drugs Reimbursed Under the Medicaid Prescription Drug Program

This final audit report points out that significant Medicaid savings can be achieved by limiting reimbursement of six ulcer treatment drugs to the manufacturer's recommended dosages. We reviewed reimbursement records for 1,600 randomly selected Medicaid recipients in eight States who received ulcer treatment therapy through at least 1 of 6 ulcer treatment drugs. We computed a potential cost savings of $116,133 for Calendar Year 1990 for 606 recipients in our sample that received dosages in excess of the manufacturers' recommendations. We estimate that national savings could total about $112 million annually. We recommended that the Health Care Financing Administration encourage States to establish procedures that limit payment for the six ulcer treatment drugs to the dosages recommended by the manufacturers.