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|
|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|
|Georgia||$13,205,614 4||Single-Source||$2,465,042 4||$3,627,956 4|
|Indiana||$9,806,848||Single-Source||$2,280,000 3||Not Available|
|Kansas||$4,170,742 8||Single-Source||Not Available||Not Available|
|Michigan||$6,625,762 7||Single-Source||$1,964,919 7||$1,193,894 7|
|New Hampshire||$621,931||Single-Source||$78,914||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|
|West Virginia||$6,529,169 3||None12|
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)
|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
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.