APPENDIX A

Table 1. Summary of 2001 State Medicaid Data for Physician-Administered Drugs

This table incorporates the States’ responses to our information request. From January through March 2003, we collected a formal set of data from the 49 States (i.e., 48 States and the District of Columbia) that participate in the Medicaid Drug Rebate Program. We specifically asked States to provide us with financial data for physician-administered drugs only, and not to include crossover drug claims from Medicare. A number of States included vaccines and immunizations in the financial data they sent us. However, these products are not covered under the Medicaid Drug Rebate Program. Therefore, we excluded vaccine and immunization data from our analysis of payments and potential savings and from this table.

Sources: State Medicaid agency data provided to OIG January-March 2003, and CMS’s Medicaid Statistical Information System

¹After 2001, State began to collect rebates on single-source drugs.

²After 2001, State began collecting rebates for drugs billed by the 8 highest paid providers.

³Fiscal year data.

⁴Eleven months of data.

⁵Based on service (not payment) dates.

⁶This State’s data is represented entirely by local codes or non-specific codes.

⁷Includes crossover drug claims from Medicare.

⁸State did not provide financial data to us. Therefore, we used data from CMS’s Medicaid Statistical Information System.

⁹State provided us with payments but not units. Therefore, we used units from CMS’s Medicaid Statistical Information System to calculate potential savings. Potential savings are in Table 3.

¹⁰ State provided us with financial data but did not respond to the questions.

¹¹ Arizona and Tennessee did not participate in the Medicaid Drug Rebate Program at the time of our study.

¹² State said it planned to collect rebates for physician-administered drugs in the future, but the plans were not specific.

¹³ State said it had specific plans underway to collect rebates for physician-administered drugs.

¹⁴ State did not plan to collect rebates for physician-administered drugs.

Table 2. Selected Physician-Administered Multiple-Source Drugs (n=40)

Source: CMS’s 2001 list of Healthcare Common Procedure Codes

Table 3. Potential Medicaid Savings on Rebates for Physician-Administered Drugs in 2001 

Sources: State Medicaid agency data provided to the OIG January -March 2003, CMS’s Medicaid Statistical Information System, Medicaid Drug Rebate Initiative database, and Single Drug Price contractor’s Part B Drug Calculation File

¹These States began collecting rebates on physician-administered drugs after 2001.

² These States collected rebates on single-source drugs in 2001. We did not estimate potential savings on single-source drugs if a State collected rebates on these drugs . California collects rebates for single-source drugs but is not in this table because they use local codes.

³Arizona and Tennessee did not participate in the Medicaid Drug Rebate Program at the time of our study. California and Massachusetts are not in this table because they use local and non-specific codes,respectively. Hawaii, Missouri, and Pennsylvania are not in this table because they use national drug codes and collect rebates on all physician-administered drugs. Nevada is not in this table because they did not respond to our questions asking if they collect rebates for physician-administered drugs.

⁴The sum of potential savings for single-source and multiple-source drugs may not exactly equal total potential savings due to rounding.