A new audit commissioned by Ohio’s Medicaid program shows that there’s a nearly 9 percent differential between what the state pays the two companies managing Medicaid pharmacy benefits and what those companies pay pharmacies for those drugs.
The head of the office that manages Medicaid isn’t ready to say whether that’s appropriate or a rip-off.
Office of Health Transformation director Greg Moody said the $225 million differential sounds like a lot, but that it would cost the state a lot to do what the Pharmacy Benefit Managers (PBM) do. So he can’t yet say whether that spread is too big or too small.
“The PBM is going to have to demonstrate to us the value that it’s providing at that price. We welcome information from the pharmacies that challenges that number and says it’s too high,” Moody said.
Moody says he was pleased the audit showed the PBM CVS Caremark paid independent pharmacies more than its own. Moody also says this audit is the first time a state has been able to shine a light on pricing like this, because he says drug companies go to what he calls extreme lengths to keep prices secret.