CMS should work with States to improve the quality of claims data submitted by providers and pharmacies.

The Medicaid drug rebate program is a significant source of savings for States and the Federal Government. Sometimes, however, States and drug manufacturers do not agree on the amount of money that manufacturers owe in rebates. Disputes are a matter of concern because they can lead to inefficient use of resources and lost money for States and the Federal Government. Once a drug manufacturer initiates a dispute, States often struggle to provide the data necessary to resolve it. States reported difficulties in providing claims data or source data to help resolve disputes. We recommend that to help prevent and resolve drug rebate disputes, CMS should work with States to improve the quality of claims data submitted by providers and pharmacies.Medicaid Drug Rebate Dispute Resolution Could Be Improved (OEI-05-11-00580)