Serious questions remain in push for Medicare reform

Medicaid is a lifeline for nearly three and a half million of Ohio's most vulnerable and underserved residents. Franklin County is no exception.

In fact, there are more than 400,000 people in our county enrolled in Medicaid who otherwise may not have access to health insurance or be able to afford prescription medication – and who could be impacted by shortcomings of the program.

That's why I was the first to raise objections to a planned reform to Medicaid's open enrollment process that could have resulted in obstacles to coverage. I am pleased that the Ohio Department of Medicaid acknowledged concerns, reevaluated, and decided not to proceed.

Ensuring the effectiveness of the daily operations of the Ohio Department of Medicaid is a significant task. Yet the department is also preparing for the eventual expiration of the federal COVID health emergency that will require the state and county agencies to complete a process to roll off newly ineligible Medicaid recipients.

The Ohio Department of Medicaid is also in the midst of an overhaul of the program's operations as many significant reforms are set to confront the department simultaneously. Among them, perhaps the greatest challenge for the department will be an attempt to address the pharmacy benefit manager (PBM) issues by switching to a single pharmacy benefit manager on Oct. 1.

For years, pharmacy benefit managers - privately-run middlemen in the prescription drug supply chain - have been excessively profiting at the expense of taxpayers using an illegal "clawback" tactic. Not only does this pervasive problem hurt local pharmacies, but it drives up drug prices.

My former colleagues in the legislature and the Ohio Department of Medicaid are right to be seeking this fix, as it will be easier to hold a single pharmacy benefit manager accountable.

Yet there are concerns the planned reform by the Ohio Department of Medicaid has shortcomings while rushing it to the finish line.

As recently reported, Ohio community pharmacists could be forced out of business due to untenable terms. Without community pharmacies, access to medicine would be decreased — especially in some parts of the state with the highest rates of poverty and Medicaid members.

When people lack access to medication for chronic or behavioral health conditions, it's harder for them to keep a job and keep a roof over their head.

Pharmacists have also expressed concern with the lack of transparency in the process leading up to this point. Unfortunately, transparency issues related to their contractors like pharmacy benefit managers are not new for ODM.

I am hopeful that the Ohio Department of Medicaid will once again be open to feedback and willing to take the necessary time to reevaluate to ensure the best outcome for Medicaid consumers and taxpayers.

There are outstanding questions that need answers related to community pharmacies, access to prescription drugs, transparency, and accountability for pharmacy benefit managers.

I encourage the public, the legislature, and its Joint Medicaid Oversight Committee to seek answers in pursuit of a more perfect Medicaid program. Millions of our fellow Ohioans' health and well-being are depending on it.

Erica C. Crawley is a Franklin County commissioner, U.S. Navy veteran and former state representative.

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Erica C. Crawley

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