Purpose

To determine the implementation status of the recommendation made in our audit report, United HealthCare: Empire Plan Drug Rebate Revenue (2016-S-7).

Background

The New York State Health Insurance Program (NYSHIP) provides health insurance coverage to about 1.2 million active and retired State, participating local government, and school district employees, and their dependents. The Empire Plan is the primary health benefits plan for NYSHIP, serving about 1.1 million members. The New York State Department of Civil Service (Department) contracted with United HealthCare (United) to administer the Empire Plan’s prescription drug program from January 1, 2008 through December 31, 2013. In accordance with the contract, United was required to negotiate agreements with drug manufacturers for rebates, discounts, and other considerations and pass 100 percent of the value of the agreements on to the Department.

Our initial audit report, which was issued on November 1, 2016, found that United did not remit $1,498,719 in rebate revenue to the Department. We made one recommendation to United to remit the $1,498,719 in rebates to the Department.

Key Finding

• United officials fully implemented the recommendation made in our initial audit report. On December 1, 2016, United remitted $1,498,719 in rebate revenue to the Department.

Other Related Audit/Report of Interest

New York State Health Insurance Program: United HealthCare - Empire Plan Drug Rebate Revenue (2016-S-7)