Medicaid managed care plan to rework pharmacy benefits contracts

Officials at one of Ohio’s Medicaid managed care plans have agreed to rework its pharmacy benefits contracts to ensure taxpayers are getting the best deal for their dollar (Source: “Medicaid pharmacy management called ‘a public embarrassment,’” Columbus Dispatch, May 10, 2018).

It’s the first time that a plan — CareSource Ohio — publicly agreed to make changes.

The system that the Ohio Department of Medicaid uses to pay most of the $3 billion it spends each year on prescription drugs has come under intense scrutiny this year. More than $2.5 billion is paid to five managed-care plans that contract with pharmacy-benefit managers, which set reimbursements to pharmacies and determine how much to bill health-care plans — and, ultimately, the taxpayers.

Since March, the Columbus Dispatch has been reporting on allegations that CVS Caremark — pharmacy-benefit manager to four of the five Medicaid plans — has cut reimbursements to pharmacies far below the amount it has billed the plans, which has put financial pressure on competitors. CVS strongly denies the accusations, and last month the company agreed to share proprietary pricing data with the state so the Department of Medicaid can analyze its pricing policies.