November 4, 2014—The Department of Health and Human Services Office of Inspector General is assessing the risk of manufacturer discounts and rebates both being paid on 340B-purchased drugs dispensed to Medicaid managed care beneficiaries, the OIG said in its fiscal year 2015 work plan. [ms-protect-content id=”2799″]
The Affordable Care Act required states for the first time to collect manufacturer rebates on drugs dispensed to Medicaid managed care enrollees. The ACA, however, also specifically excluded drugs subject to 340B discounts from this new requirement.
The OIG study, slated for release next year, will describe states’ efforts to prevent such rebate requests. “Existing tools and processes used to prevent duplicate discounts in fee-for-service Medicaid may not be sufficient for drugs paid through Medicaid MCOs,” the OIG said.
At a meeting of 340B stakeholders last July, a senior pharmacy official at the Centers for Medicare & Medicaid services said that it is up to states and their MCO contractors to make sure that 340B claims are exempt from Medicaid managed care rebate requests. In a report on Medicaid drug rebate dispute resolution in August, OIG noted that CMS had indicated it that it was working with the Health Resources and Services Administration on guidance to states about identifying claims submitted to Medicaid for 340B-purchased drugs.
Also in its 2015 work plan, the OIG repeated that it is working on a study to determine how much Medicare Part B spending could be reduced if Medicare were able to share in the savings for 340B-purchased drugs. It announced the study in its 2014 work plan.
The OIG also said it is still working on a pair of studies on how provider-based hospital outpatient clinics affect Medicare’s finances. [/ms-protect-content]