Ohio’s Auditor of State Releases Medicaid PBM Audit Report
The Ohio Auditor of the State released the results of his review of Ohio’s Medicaid Managed Care pharmacy services this week. This audit was requested by the Ohio General Assembly in response to concerns over declining reimbursements to independent community pharmacies, lack of transparency, and potential conflicts of interest.
The Ohio Pharmacists Association has worked diligently with Ohio officials to inform them of the issues in this report, and summarized the key findings as follows:
- The difference between what pharmacies are paid and what pharmacy benefit managers (PBMs) report back to the plans, commonly referred to as “spread,” has been growing and hit its peak in the fourth quarter of 2017.
- An overwhelming portion of PBM spread is occurring on generic drugs.
- Spread pricing totals wildly varied from region to region.
- There is a disconnect between Medicaid pharmacy costs and what pharmacies are reimbursed.
- The data confirms a high number of pharmacy closures amid reimbursement cuts.
- The spread totals were highest on specialty drugs, which are typically dispensed at PBM-owned pharmacies.
In anticipation of the audit results, the Ohio Department of Medicaid announced this week that it plans to terminate contracts, effective January 2019, with PBMs using the secretive pricing method in favor of a more transparent model.