Auditor Says New Pricing Model For Medicaid Prescriptions Might Not Be Any Better

Aug 17, 2018

The state auditor is urging lawmakers to tell Ohio Medicaid to halt its plan to change its contracts with two pharmacy benefits managers over the way those prescription drug middlemen price their services.

Auditor Dave Yost told a panel of lawmakers that he agrees with an Ohio Medicaid report showing the state paid $224 million more to CVS Caremark and Optum than they paid out to pharmacies. Yost also says he found those PBMs billed the state 31 percent more for generics, which make up 86 percent of Medicaid prescriptions.

But he wants Ohio Medicaid to put a seven month hold on moving to a pass-through pricing model till more data is received.

“The pass-through model may end up costing us more money than what we’re doing now," said Yost.

Ohio Medicaid said a pass-through model will bring more transparency.

CVS Caremark said in a statement its services to the five Medicaid managed care plans save the state $145 million a year.