Rebates

Medicaid drug rebates reduce prescription-drug costs through amounts owed by manufacturers under federal and supplemental agreements. Audits examine invoicing, collection, dispute resolution, reconciliation, and the accuracy of utilization data used to calculate rebates.

Missed, delayed, or incorrectly calculated rebates increase the net cost of Medicaid pharmacy benefits. Effective controls must connect claims data, manufacturer invoices, collections, and unresolved disputes so that every amount owed can be identified and recovered.

1. Molina did not consistently submit dental value-added services encounters with the correct financial arrangement code. 13,654 of 23,303 encounters (59%) were coded as payable dental services (financial arrangement code 04) instead of value-added services (financial arrangement code 11), totaling $560,777.

   Dental Value-Added Services—Molina Healthcare · Texas Health and Human Services Office of Inspector General · Feb 20, 2026

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

   Missouri Medicaid Rebates for Physician-Administered and Pharmacy Drugs · Office of Inspector General, U.S. Department of Health and Human Services · Feb 2026

3. The State agency did not invoice for, and collect from manufacturers, estimated rebates totaling $8.2 million ($6.1 million Federal share) for physician-administered drugs dispensed to MCO enrollees.

   West Virginia Medicaid Managed-Care Rebates Associated With Physician-Administered Drugs · Office of Inspector General, U.S. Department of Health and Human Services · Feb 2026

1. Implement a pass-through pricing model by default, ensuring all rebates and cost savings are passed through to CCOs and Medicaid.

   Poor Accountability and Transparency Harm Medicaid Patients and Independent Pharmacies · Oregon Secretary of State, Audits Division · Aug 2023

2. Review its state fiscal year 2023, 2024, and 2025 FSRs to determine whether any reported dental value-added services expenses were included in the medical expenses.

   Dental Value-Added Services—Molina Healthcare · Texas Health and Human Services Office of Inspector General · Feb 20, 2026

3. Refund to the Federal Government $6,055,786 (Federal share) for claims for single-source physician-administered drugs that were ineligible for Federal reimbursement.

   West Virginia Medicaid Managed-Care Rebates Associated With Physician-Administered Drugs · Office of Inspector General, U.S. Department of Health and Human Services · Feb 2026

• Missouri Medicaid Rebates for Physician-Administered and Pharmacy Drugs
• West Virginia Medicaid Managed-Care Rebates Associated With Physician-Administered Drugs
• Dental Value-Added Services—Molina Healthcare
• Managed Care Pharmacy Benefit Services – Aetna
• Managed Care Pharmacy Benefit Services – Wellpoint
• Maryland Department Of Health Pharmacy Services Audit Report
• Medicaid Program: Improper Payments for Drugs Without a Federal Drug Rebate Agreement
• Poor Accountability and Transparency Harm Medicaid Patients and Independent Pharmacies
• Medicaid Program: Maximizing Drug Rebates Under the Federal Medicaid Drug Rebate Program
• An Audit Report on Medicaid Managed Care Contract Processes at the Health and Human Services Commission
• Department of Social Services Prescription Drug Oversight