Evidence record
Selected Diabetes and Weight Loss Drugs Were Dispensed to Michigan Medicaid Managed Care Enrollees in Accordance With Federal and State Requirements
- Jurisdiction
- Michigan
- Audit organization
- U.S. Department of Health and Human Services Office of Inspector General
- Publication date
- March 2026
- Source record
- Original document linked
Findings
2
Recommendations
1
Overall conclusion
Because the State agency ensured, for the sample items we reviewed, that the MCOs followed all outpatient prescription drug coverage and utilization requirements that were in place during our audit period, including prior authorizations and quantity limits, this report contains no recommendations.
Scope
Audit covered $524.9 million in Michigan Medicaid managed care encounter claims for 13 selected diabetes and weight loss drugs during October 1, 2023, through September 30, 2024. A stratified random sample of 105 encounter claims totaling $107,535 was reviewed to determine whether prior authorizations and quantity limits were met, and to verify the dispensing history aligned with State requirements.
Findings (2)
Each finding has a stable link.
- F-1231
During our audit period, selected diabetes and weight loss drugs were dispensed to Michigan Medicaid managed care enrollees in accordance with Federal and State requirements.
- F-1232
Michigan ensured that the managed care organizations followed all outpatient prescription drug coverage and utilization requirements that were in place during our audit period, including prior authorizations and quantity limits, for all 105 encounter claims in our stratified random sample.
Recommendations (1)
- R-1092
This report does not contain recommendations.