PRMP respectfully disagrees with this finding. The responsibility for reporting quarterly drug utilization to manufacturers within 60 days after the end of each quarter, as well as the requirement for manufacturers to remit rebate payments within 30 days of receiving utilization data, is delegated t...
PRMP respectfully disagrees with this finding. The responsibility for reporting quarterly drug utilization to manufacturers within 60 days after the end of each quarter, as well as the requirement for manufacturers to remit rebate payments within 30 days of receiving utilization data, is delegated to the Puerto Rico Health Insurance Administration (ASES) through the Memorandum of Understanding (MOU). PRMP is confident in this delegated process, particularly given that it was subject to audit and resulted in no findings for the year ended June 30, 2025. PRMP obtained the Puerto Rico Health Insurance Administration (A Component Unit of the Commonwealth of Puerto Rico) Financial Statements and Compliance Audit of Federal Financial Assistance for the Fiscal Year Ended June 30, 2025, and noted the following opinion: Opinion on Each Major Program (Page 46) We have audited the Puerto Rico Health Insurance Administration’s (the Administration) compliance with the types of compliance requirements identified as subject to audit in the OMB Compliance Supplement that could have a direct and material effect on each of the Administration's major federal programs for the year ended June 30, 2025. The Administration's major federal programs are identified in the summary of auditor's results section of the accompanying schedule of findings and questioned costs. In our opinion, the Administration complied, in all material respects, with the types of compliance requirements referred to above. Furthermore, the Medicaid Program initiates reimbursement of drug rebates to CMS once the following conditions are met: - The actuarial team completes its analysis and validation of the allocation of funds to be returned to CMS for each grant and population subject to the applicable FMAP rates. - PRMP receives the corresponding invoice to process refunds to ASES, reflecting the deduction of drug rebate collections. - The Puerto Rico Medicaid Program remits drug rebate funds to the Payment Management System Accordingly, the Puerto Rico Medicaid Program does not concur with the finding asserting that rebate collections were not properly identified, recorded, or credited to the Medicaid Program in a timely manner. Refunds are processed within the same quarter—or at the beginning of the subsequent quarter—following receipt of the final actuarial data, which provides the required distribution and identifies the associated grants. This sequencing ensures that remittances are based on complete, validated information and are aligned with the applicable federal funding allocations.