In recent months, controversy over the Ohio Medicaid program has provided a rare window into some of the fees paid to pharmacy benefit managers and the subsequent effect on prescription drug costs. Now, an audit finds a new twist: A managed care plan that contracted with the state program collected $20 million through a curious arrangement that has raised concern among state officials.

Specifically, the Buckeye Health Plan is one of a handful of managed care plans hired by Ohio Medicaid to provide prescription drug benefits. The plans, in turn, contracted with two PBMs — CVS Caremark (CVS) and Optum Rx — to do much of that work. However, the plans were recently told to end the contracts over pricing practices that cost the state tens of millions of dollars.

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  • On the money, Jeff!
    $20M might only be a drop in ocean for mega pharma, but its probably enough funds to provide state-of-the-art medicine for about 100 patients. Just adding a bit of perspective.

  • Good investigation work Ed !!!! Yes, it would be a wise move for The Inspector General in every state to look into every PBM in this country. I’ll bet you 10 cents
    that they will uncover hundreds of millions , maybe even a billion dollars of fraud by the PBM’s !

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