Ohio shakes up PBM landscape, plans to contract with 1 PBM: 6 things to know

Ohio House and Senate leaders have agreed on a plan that will reshape how pharmacy benefit management works in the state Medicaid program, according to the Columbus Dispatch.

Six things to know:

1. The agreement, which is part of the state's two-year budget deal, directs Ohio's Medicaid program to cut out private managed care companies and the pharmacy middleman they hire to manage pharmacy benefits. 

2. Under the agreement, the Medicaid program will contract directly with a single pharmacy benefit manager, who will be chosen by the Medicaid department. 

3. The PBM chosen by the Medicaid department will be required to disclose to the state how much it pays for drugs and how much it reimburses pharmacies, among other financial details. It will also be required to disclose any conflicts of interest.

4. The contract for the single PBM in charge of pharmacy benefits will be re-bid every four years, and PBMs could be fined or fired for noncompliance with the new regulations.

5. The agreement would allocate $100 million for pharmacies in an effort to make up for low reimbursements from Medicaid.

6. CVS Caremark and OptumRx, the PBMs of Ohio's Medicaid program, have come under scrutiny in the state for a lack of transparency. A study released in Ohio last year found PBMs billed Medicaid $244 million more than they paid pharmacies.

Access the full report here

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