A recent HHS Office of Inspector General (OIG) review, Multi-State Review of Centers for Medicare & Medicaid Services Medicaid Drug Expenditure Controls, found that $258.8 million ($166.6 million federal share) out of $41.6 billion in state Medicaid outpatient prescription drug claims in 14 states were unallowable or potentially unallowable because the drugs were not listed on quarterly drug tapes, the drugs were terminated or less-than-effective, or the expenditures were inadequately supported. According to the OIG, CMS and the states lack adequate controls to ensure that all drug expenditures comply with federal requirements, and the OIG offered a series of recommendations to improve these controls. For instance, the OIG recommended that CMS work with drug manufacturers to ensure that information on the quarterly drug tapes is complete and accurate, and take appropriate action if manufacturers are not timely in providing complete information to CMS. CMS agreed with this recommendation, but disagreed with the OIG that CMS should report terminated drug expenditures to state agencies on the quarterly Utilization Discrepancy Reports and require states to use these reports to enhance compliance. CMS partially agreed with other OIG recommendations involving instructing state agencies on ways to improve controls, including additional safeguards for terminated drugs.