Request for Prescription Claims Data

steven zielinski filed this request with the Department of Health of Virginia.
Est. Completion None


From: steven zielinski

To Whom It May Concern:

Pursuant to Virginia Freedom of Information Act, I hereby request the following records:

Virginia Department of Medical Assistance Services, Division of Health Care Services

Claims data used by the state to determine Medicaid Drug Rebate Program (“MDRP”), State Pharmaceutical Assistance Program (“SPAP”), and Aids Drug Assistance Program (“ADAP”) rebate-eligible units. These data are likely provided to the state’s rebate vendor, OptumRx, who uses these data when invoicing drug manufacturers for rebates.

Pharmaceutical manufacturers engage Kalderos to assist them with performing "audits" of Medicaid claims data used by states such as Virginia for determining Medicaid Drug Rebate Program rebates due to the state. This "audit" right is granted to drug manufacturers as part of the Medicaid Drug Rebate Program statute [See] as well as under the rebate agreement entered into with the HHS Secretary [see]

Kalderos has been granted authority by its clients (pharmaceutical manufacturers) to obtain claims level data on their behalf. As such, we respectively request Virginia to provide responsive data and responsive data elements Medicaid claims data to enable us to perform validation tests on behalf of our clients. We will provide letters from our drug manufacturer clients granting us such authority upon request.

Our clients desire that we focus on looking for suspected 340B duplicate discounts. To enable us to perform 340B duplicate discount validation tests, we must receive the following fields without encryption: Pharmacy ID, Date of Service, Prescriber ID, and Rx ID. We respectively request that these data be provided electronically. We will be happy to work with state personnel to define exactly which data attributes are responsive and data delivery methods that work for both parties (such as secure FTP).

Current attempts to obtain this information from OptumRx has failed. The state’s rebate vendor, OptumRx, suggested that we initiate a request under the state’s open records law to obtain the data we need. Kalderos’ interaction with OptumRx has been with Ashley Norvall, Sr. Rebate Analyst, Industry Relations OptumRx. 1-404-267-6615

The time period we request claims data is for rebate quarters 2014Q2 to 2016Q4. Please note that our request for data will be ongoing on a quarterly basis, and we desire to work out an arrangement with the state for providing data in a systematic and recurring basis.

This request is being made for commercial purposes.

In the event that there are fees, I would be grateful if you would inform me of the total charges in advance of fulfilling my request. I would prefer the request filled electronically, by e-mail attachment if available or CD-ROM if not.

Thank you in advance for your anticipated cooperation in this matter. I look forward to receiving your response to this request within 5 business days, as the statute requires.


steven zielinski

From: Hilbert, Joseph (VDH)

Mr. Zielenski:

The Virginia Department of Health does not have any documents that are responsive to your request. I suggest that you resubmit your request to the Virginia Department of Medical Assistance Services, which administers the Virginia Medicaid program.

Sent from my iPhone

From: steven zielinski


Thanks so much for your help with this request! I really appreciate it.

steven zielinski


There are no files associated with this request.