The OIG recently examined how states that pay for drugs through Medicaid managed care organizations (MCOs) identify and exclude 340B drug claims when collecting Medicaid rebates, since states are prohibited from collecting “duplicate discounts” (i.e., when manufacturers pay Medicaid rebates on drugs sold at the discounted 340B price).  The OIG also reviewed potential vulnerabilities that could inhibit correct rebate collection for MCO drugs.  The OIG found that most states identify providers using 340B purchased drugs, but the OIG found that such provider-level methods may not accurately identify all individual 340B drug claims.  On the other hand, a claim-level mechanism can more accurately identify 340B drug claims and help states correctly collect rebates, according to the OIG.  The OIG recommends that CMS require states to use claim level method to identify 340B claims, but CMS disagreed since the statute does not include such a requirement.  The OIG also recommends that the Health Resources and Services Administration (HRSA) clarify its guidance on preventing duplicate discounts for MCO drugs; HRSA concurred with this recommendation.  For additional information see the full report, “State Efforts to Exclude 340B Drugs from Medicaid Managed Care Rebates.”