New York spent nearly $30 million more than it should have on a drug that prevents lung infections in premature babies because of problems with the state Health Department’s processing system, according to an audit released today by Comptroller Thomas DiNapoli.
Between July 1, 2005 and June 30, 2008, about $29.7 million of the $146.5 million the state paid in Medicaid claims for Synagis did not follow the Health Department’s guidelines. The drug is supposed to be given to children under 2 at the beginning of the human respiratory syncytial virus season, and no more than five monthly doses are supposed to be given during the season, which runs from November to April.
Of the $29.7 million, pharmacies were reimbursed $17.9 million for Synagis claims outside the virus season, $6.2 million was paid for claims in excess of the five monthly doses, $3.3 million was paid for children older than 2, and $2.3 million was for medication doses less than 21 days apart, the audit found.
“New York doesn’t have health care dollars to waste,” the comptroller said in a statement. “Every one of those dollars needs to be spent the right way, especially when they’re targed toward helping babies stay healthy.”
Synagis costs about $2,000 a month for each individual. It helps decrease the virus in infants who were born prematurely or were diagnosed with serious respiratory conditions such as congenital heart disease or chronic lung disease.
DiNapoli’s office is recommending that the Health Department better monitor use of the drug to ensure compliance, develop a new education program about the drug for prescribers and better monitor its eMedNY system to ensure it doesn’t allow early refill for these prescriptions.