CMS's enhanced controls did not always prevent terminated drug utilization in Medicare Part D

HHS's Office of the Inspector General (OIG) reported recently that because the measures CMS has taken to deal with terminated drug utilization in Medicare Part D were not completely effective, CMS continued to accept some prescription drug event (PDE) data for terminated drugs in 2014 and 2015.

HHS's Office of the Inspector General (OIG) reported recently that because the measures CMS has taken to deal with terminated drug utilization in Medicare Part D were not completely effective, CMS continued to accept some prescription drug event (PDE) data for terminated drugs in 2014 and 2015. The agency has taken steps to prevent terminated drug utilization in Part D; however, it accepted PDE data for more than $31 million in gross drug costs for 3,705 terminated drugs in those 2 years. OIG said that CMS did not compare the data on termination dates in its quarterly Medicaid drug rebate files with FDA's file, did not examine the discrepancies between the two data sources, and did not update its system edits in a timely fashion. OIG recommended "that CMS continue to strengthen its internal controls to ensure that all PDE data for terminated drugs are rejected by working with FDA to verify the accuracy of drug termination dates, to include comparing the information on termination dates in its two data sources, investigating discrepancies between the data sources, and verifying termination dates with the manufacturers; and by updating its system edits with a new version of FDA's file on a more timely basis." OIG added that while CMS agreed with the second recommendation, it does not "with our first recommendation, stating that although it remains committed to strengthening its internal controls to ensure that PDE data for terminated drugs are rejected, it regards FDA as the expert authority and source for national drug code listing information."