APPENDIX A

Contact Form - Your First Step

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.

State Physician-Administered Drug Payments in 2001 Physician-Administered Drugs for which States Collected Rebates in 2001 Rebates Requested of Drug Manufacturers for Physician-Administered Drugs in 2001 Rebates Collected from Drug Manufacturers for Physician-Administered Drugs in 2001
Alabama $13,196,168 8 None1
Alaska $2,229,910 None13
Arkansas $4,159,582 None13
California6 $59,278,322 Single-Source $6,417,891 $5,445,273
Colorado $3,211,272 3 None14
Connecticut $3,776,003 8 Single-Source Not Available Not Available
Delaware $55,008 Single-Source Not Available Not Available
District of Columbia $995,166 None12
Florida $22,037,705 None1
Georgia $13,205,614 4 Single-Source $2,465,042 4 $3,627,956 4
Hawaii $479,692 All $237,295 $135,872
Idaho $1,830,202 None12
Illinois9 $1,612,548 None12
Indiana $9,806,848 Single-Source $2,280,000 3 Not Available
Iowa $5,407,563 8 None14
Kansas $4,170,742 8 Single-Source Not Available Not Available
Kentucky $1,995,578 None1
Louisiana $3,723,133 None1
Maine $1,840,082 None12
Maryland $25,235,109 None1
Massachusetts 6 $190,676 None13
Michigan $6,625,762 7 Single-Source $1,964,919 7 $1,193,894 7
Minnesota $5,451,191 None13
Mississippi $5,606,025 None12
Missouri $9,979,292 All $2,887,966 $2,875,550
Montana $1,896,598 3 None12
Nebraska9 $3,174,260 5 None12
Nevada $4,510,532 Not Available10
New Hampshire $621,931 Single-Source $78,914 Not Available
New Jersey $2,274,470 None14
New Mexico $563,289 None12
New York $23,301,898 None12
North Carolina $14,817,041 Single-Source $3,522,962 $3,285,105
North Dakota $367,185 None12
Ohio $13,344,648 None14
Oklahoma $3,880,609 None12
Oregon $8,569,989 Single-Source $1,437,366 Not Available
Pennsylvania $772,931 All Not Available Not Available
Rhode Island $527,412 8 Single-Source Not Available Not Available
South Carolina $10,277,645 Single-Source Not Available Not Available
South Dakota $591,771 None13
Texas $35,534,137 None13
Utah $1,095,075 None12
Vermont $1,247,256 None1
Virginia $2,597,819 Single-Source $612,957 Not Available
Washington $17,740,284 None2
West Virginia $6,529,169 3 None12
Wisconsin $3,548,728 Single-Source $634,259 Not Available
Wyoming $269,851 None14
4911 $364,153,722 $22,539,571 $16,563,651

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)

Procedure Code Description
J0640 INJECTION, LEUCOVORIN CALCIUM, PER 50 MG
J1040 INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG
J1100 INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1MG
J1245 INJECTION, DIPYRIDAMOLE, PER 10 MG
J1561 INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, 500 MG
J1562 INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, 5 GMS
J1563 INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, 1G
J1631 INJECTION, HALOPERIDOL DECANOATE, PER 50 MG
J1642 INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH), PER 10 UNITS
J1644 INJECTION, HEPARIN SODIUM, PER 1000 UNITS
J1750 INJECTION, IRON DEXTRAN, 50 MG
J1885 INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG
J2000 INJECTION, LIDOCAINE HCL, 50 CC
J2275 INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE SOLUTION), PER 10 MG
J2550 INJECTION, PROMETHAZINE HCL, UP TO 50 MG
J2680 INJECTION, FLUPHENAZINE DECANOATE, UP TO 25 MG
J2912 INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
J3370 INJECTION, VANCOMYCIN HCL, 500 MG
J7050 INFUSION, NORMAL SALINE SOLUTION, 250 CC
J7190 FACTOR VIII (ANTIHEMOPHILIC FACTOR, HUMAN) PER I.U.
J7192 FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U.
J7194 FACTOR IX, COMPLEX, PER I.U.
J7619 ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER 1 MG
J9000 DOXORUBICIN HCL, 10 MG
J9040 BLEOMYCIN SULFATE, 15 UNITS
J9060 CISPLATIN, POWDER OR SOLUTION, PER 10 MG
J9062 CISPLATIN, 50 MG
J9181 ETOPOSIDE, 10 MG
J9182 ETOPOSIDE, 100 MG
J9190 FLUOROURACIL, 500 MG
J9209 MESNA, 200 MG
J9265 PACLITAXEL, 30 MG
J9370 VINCRISTINE SULFATE, 1 MG
Q0136 INJECTION, EPOETIN ALPHA, (FOR NON ESRD USE), PER 1000 UNITS
Q9930 INJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 30
Q9932 INJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 32
Q9933 INJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 33
Q9934 INJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 34
Q9935 INJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 35
Q9936 INJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 36

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

Table 3. Potential Medicaid Savings on Rebates for Physician-Administered Drugs in 2001 table-3-potential-medicaid-savings-on-rebates

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.

Recommendation | Main | Appendix B