In an unexpected move, Ohio officials are immediately ending contracts with two of the largest pharmacy benefit managers over pricing practices that cost the state tens of millions of dollars.

The decision comes amid controversy over the fees that PBMs pay pharmacies for medicines and what they bill back to the Ohio Medicaid program, a practice known as spread pricing. A report commissioned by state officials found that two PBMs — CVS Caremark (CVS) and OptumRx — reaped more than $223 million by working on behalf of state Medicaid plans during a recent 12-month period.

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