Missouri Medicaid Rebates for Physician-Administered and Pharmacy Drugs

Between January 1, 2019, and December 31, 2022, Missouri did not invoice for, and collect from manufacturers, rebates for $9.7 million (Federal share) for physician-administered drugs and $2.5 million (Federal share) for pharmacy drugs.

The State agency did not invoice rebates for $165,783 (Federal share) for other physician-administered drugs that could have been eligible for rebates.

The State agency did not invoice for rebates on $14,489,535 ($9,510,305 Federal share) for single-source physician-administered drugs.

The State agency did not invoice manufacturers for rebates on $311,551 ($204,564 Federal share) for top-20 multiple-source physician-administered drugs.

The State agency did not collect rebates for $3,773,346 ($2,478,099 Federal share) for pharmacy drugs.

The State agency did not implement previous audit recommendations.

Refund to the Federal Government $9,510,305 (Federal share) for claims for single-source physician-administered drugs that were ineligible for Federal reimbursement.

Refund to the Federal Government $204,564 (Federal share) for claims for top-20 multiple-source physician-administered drugs that were ineligible for Federal reimbursement.

Work with CMS to determine the unallowable portion of $165,783 (Federal share) for claims for other physician-administered drugs that may have been required to be invoiced, and invoice drug manufacturers for rebates for those drugs.

Obtain rebates for the pharmacy drugs totaling $2,478,099 (Federal share), and refund the Federal share.

Work with CMS to resolve all of the recommendations made in our previous audit report.

Strengthen internal controls to ensure that all pharmacy and physician-administered drugs eligible for rebates are invoiced.