The report explores a controversial practice called spread pricing, where PBMs pay drugstores one price for a treatment while charging more to their health plan clients. Critics of the practice say the difference in pricing adds to PBMs profits.
The report found that Kentucky Medicaid insurers paid $957.7 million to the four PBMs that the state program works with. Of that amount, PBMs kept 13 percent of $123.5 million through using the pricing tactic.
The size of the spread has increased by more than a third since 2017.
Companies that run the PBMs in the state’s Medicaid program, including CVS Health and Cigna, claim their clients knowingly enter into the spread-pricing agreements and that those agreements help fund benefits for patients and stabilize drug costs.
Read the full report here.
More articles on pharmacy:
FTC settles with Teva over ‘pay-for-delay’ deals
Top 10 fatal or harmful prescribing errors
Civica Rx will start as middleman for drugmakers, hospitals, Bloomberg says
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.
