Ohio’s tale of drug-price excess just got about
We already knew pharmacy benefit managers — middleman companies handling the prescription-drug benefit for Ohio’s Medicaid program — overcharged taxpayers by anywhere from
Now we learn that one of the state’s Medicaid plans hired a second middleman, which soaked up another
To review: Ohio’s Medicaid program contracts with five private managed-care organizations to act as insurance companies to Ohio’s 3 million Medicaid recipients. Those companies then hire PBMs for drug claims.
CVS Caremark, a PBM owned by the pharmacy giant, has been hired by four of the five plans; the other uses
Thanks largely to complaints from independent pharmacists and reporting by
They could do this unnoticed because terms of the contracts between the PBMs and the managed-care plans were secret; no one knew that the PBM was in many cases charging taxpayers high prices for certain drugs but reimbursing pharmacists a much lower amount and pocketing the difference.
State officials initially discredited the suggestion of a problem. Under public pressure, they commissioned a study which found that the PBMs were charging a premium of
The same contract secrecy apparently allowed Buckeye Community Health Plan to hire its corporate relative,
The companies say that they aren’t doing the same things — that each focuses on different tasks. Still, Buckeye’s average fee per prescription filled, at
We’re glad that HealthPlan Data Solutions, the Columbus consulting firm hired to audit the Medicaid drug program, has uncovered these glaring problems. The
It is troubling, however, that state officials opted not to disclose the
When reporters spotted the apparent redundancy in the report and asked about it, officials at first downplayed the issue.
Since then, a Medicaid spokesman has allowed that the arrangement might have some “inefficiencies” and that
The state has pledged to make next year’s Medicaid contracts, including subcontracts reached with PBMs, transparent. That is, indeed, the best way to enable public oversight and prevent the appalling self-dealing that has gone on out of public view.
But public confidence in the competence of Ohio Medicaid will be higher if state officials acknowledge the problems more forthrightly.
CREDIT: THE COLUMBUS DISPATCH