Stark pharmacies feeling the PBM crunch
The report, requested by state legislators, may also provide more information on whether PBMs are inadequately reimbursing pharmacists across the state, including in
A local pharmacist and the
CVS Caremark is the PBM for four of the five managed care organizations that manage Medicaid benefits under a contract with
Local pharmacists said
An audit released in June commissioned by Ohio Medicaid found CVS Caremark and Optum RX, the other Medicaid PBM in
In advance of the release of Yost's report, the
The city of
She cited Caremark's pricing practices with local pharmacists. She also said CVS Caremark last year increased by 10 times a generic medication crucial to keeping a city employee and an employee's family member alive, required the city's plan to get the drug at the higher price from a CVS specialty pharmacy and prohibited the city's plan from getting the drug at a cheaper price from a competing pharmacy.
"The pricing structure isn't fair," said Cole, adding Caremark's rebates for certain drugs also were not timely. "It's not fair to local pharmacies."
Cole said she will present a plan on the transition to a new PBM to
Complicating the legal stakes for local pharmacists, the contracts they have with CVS Caremark prohibit them from criticizing the company, said Ciaccia.
Local pharmacists react
"Ohio Medicaid is heavily dominated by a single PBM, who controls 35 percent of our overall business," Fettman's statement said.
"After cutting our reimbursements in
Ciaccia said member pharmacists have told him if they refuse to accept Caremark's Medicaid drug reimbursement rates, they also risk losing the business for patients covered by a private insurance plan using CVS Caremark.
Fettman's statement said, "At my pharmacy, more than 80 percent of my patients are represented by the three large PBMs. ... So, it's sign the contract, or you'll have no patients. It's all take-it-or-leave it."
Not selling
He confirmed CVS last year offered to buy his pharmacy as
"I have no interest in selling," White said. "I have a lot of fabulous people working for me. If I retire or sell my business, where are they going to go? ... I want to remain a pharmacist until I die."
It said CVS Caremark negotiates prices with drug makers and plays an important role in helping employers, unions, health plans and government agencies control rising drug prices.
It called local, independent pharmacists "important partners" that make up 40 percent of its network, whom they reimburse "at competitive rates" higher than rates paid to CVS pharmacies. The statement said independent pharmacies also negotiate their own "substantial" discounts with drug manufacturers and wholesalers. And CVS Caremark's PBM business is strictly prohibited from coordinating with
Ciaccia said CVS Caremark may be reimbursing independent pharmacies at rates about 3.5 percent higher than CVS pharmacies, but the spread between the reimbursements and what it charges Medicaid is so high, according to the state assessment, CVS Caremark is still making a tremendous amount of money.
State Rep.
"When you have your competitor being able to regulate the industry, and then they contact you, 'you're struggling, would you like to (be bought out)'?" he said. "It's a big threat to our local pharmacy, to our community."
West is a joint sponsor of House Bill 479, which would require pharmacists to tell patients if the out-of-pocket cost of a drug is less than the drug co-pay and charge them the lesser price.
CVS Caremark said it does not prohibit pharmacies from telling a patient if the out-of-pocket cost is lower than the co-pay for a Caremark prescription.
Reach Robert at 330-580-8327 or [email protected]
On Twitter: @rwangREP
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