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APPENDIX A

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.

StatePhysician-Administered Drug Payments in 2001Physician-Administered Drugs for which States Collected Rebates in 2001Rebates Requested of Drug Manufacturers for Physician-Administered Drugs in 2001Rebates Collected from Drug Manufacturers for Physician-Administered Drugs in 2001
Alabama$13,196,168 8None1
Alaska$2,229,910None13
Arkansas$4,159,582None13
California6$59,278,322Single-Source$6,417,891$5,445,273
Colorado$3,211,272 3None14
Connecticut$3,776,003 8Single-SourceNot AvailableNot Available
Delaware$55,008Single-SourceNot AvailableNot Available
District of Columbia$995,166None12
Florida$22,037,705None1
Georgia$13,205,614 4Single-Source$2,465,042 4$3,627,956 4
Hawaii$479,692All$237,295$135,872
Idaho$1,830,202None12
Illinois9$1,612,548None12
Indiana$9,806,848Single-Source$2,280,000 3Not Available
Iowa$5,407,563 8None14
Kansas$4,170,742 8Single-SourceNot AvailableNot Available
Kentucky$1,995,578None1
Louisiana$3,723,133None1
Maine$1,840,082None12
Maryland$25,235,109None1
Massachusetts 6$190,676None13
Michigan$6,625,762 7Single-Source$1,964,919 7$1,193,894 7
Minnesota$5,451,191None13
Mississippi$5,606,025None12
Missouri$9,979,292All$2,887,966$2,875,550
Montana$1,896,598 3None12
Nebraska9$3,174,260 5None12
Nevada$4,510,532Not Available10
New Hampshire$621,931Single-Source$78,914Not Available
New Jersey$2,274,470None14
New Mexico$563,289None12
New York$23,301,898None12
North Carolina$14,817,041Single-Source$3,522,962$3,285,105
North Dakota$367,185None12
Ohio$13,344,648None14
Oklahoma$3,880,609None12
Oregon$8,569,989Single-Source$1,437,366Not Available
Pennsylvania$772,931AllNot AvailableNot Available
Rhode Island$527,412 8Single-SourceNot AvailableNot Available
South Carolina$10,277,645Single-SourceNot AvailableNot Available
South Dakota$591,771None13
Texas$35,534,137None13
Utah$1,095,075None12
Vermont$1,247,256None1
Virginia$2,597,819Single-Source$612,957Not Available
Washington$17,740,284None2
West Virginia$6,529,169 3None12
Wisconsin$3,548,728Single-Source$634,259Not Available
Wyoming$269,851None14
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 CodeDescription
J0640INJECTION, LEUCOVORIN CALCIUM, PER 50 MG
J1040INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG
J1100INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1MG
J1245INJECTION, DIPYRIDAMOLE, PER 10 MG
J1561INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, 500 MG
J1562INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, 5 GMS
J1563INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, 1G
J1631INJECTION, HALOPERIDOL DECANOATE, PER 50 MG
J1642INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH), PER 10 UNITS
J1644INJECTION, HEPARIN SODIUM, PER 1000 UNITS
J1750INJECTION, IRON DEXTRAN, 50 MG
J1885INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG
J2000INJECTION, LIDOCAINE HCL, 50 CC
J2275INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILE SOLUTION), PER 10 MG
J2550INJECTION, PROMETHAZINE HCL, UP TO 50 MG
J2680INJECTION, FLUPHENAZINE DECANOATE, UP TO 25 MG
J2912INJECTION, SODIUM CHLORIDE, 0.9%, PER 2 ML
J3370INJECTION, VANCOMYCIN HCL, 500 MG
J7050INFUSION, NORMAL SALINE SOLUTION, 250 CC
J7190FACTOR VIII (ANTIHEMOPHILIC FACTOR, HUMAN) PER I.U.
J7192FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U.
J7194FACTOR IX, COMPLEX, PER I.U.
J7619ALBUTEROL, ALL FORMULATIONS INCLUDING SEPARATED ISOMERS, INHALATION SOLUTION ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER 1 MG
J9000DOXORUBICIN HCL, 10 MG
J9040BLEOMYCIN SULFATE, 15 UNITS
J9060CISPLATIN, POWDER OR SOLUTION, PER 10 MG
J9062CISPLATIN, 50 MG
J9181ETOPOSIDE, 10 MG
J9182ETOPOSIDE, 100 MG
J9190FLUOROURACIL, 500 MG
J9209MESNA, 200 MG
J9265PACLITAXEL, 30 MG
J9370VINCRISTINE SULFATE, 1 MG
Q0136INJECTION, EPOETIN ALPHA, (FOR NON ESRD USE), PER 1000 UNITS
Q9930INJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 30
Q9932INJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 32
Q9933INJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 33
Q9934INJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 34
Q9935INJECTION OF EPO, PER 1000 UNITS, AT PATIENT HCT OF 35
Q9936INJECTION 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.

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.

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