As the debate over prescription drug costs accelerates, a new report shows two pharmacy benefit managers reaped more than $223 million by working on behalf of Ohio Medicaid plans during a recent 12-month period. And the findings are likely to intensify scrutiny of the roles these companies play in shaping pharmaceutical costs nationwide.
From April 2017 through March 2018, CVS Caremark (CVS) and OptumRx billed $2.55 billion to a handful of managed care plans that administer Medicaid plans for Ohio residents. At the same time, the pharmacy benefit managers spent $2.3 billion for prescription medicines and services performed by pharmacies. This amounted to an 8.8 percent gain, or spread, of $223 million from a key profit center, according to the report.
Ohio state officials commissioned the report, which is apparently the first of its kind, in response to growing concerns over prescription drug costs and a lack of transparency surrounding pricing. More specifically, the state noted the Ohio Pharmacists Association had alleged pharmacy benefit managers were overbilling Medicaid managed care plans, underpaying pharmacies, and pocketing the difference.
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