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As pharmacy benefit managers undergo increasing scrutiny, two lawmakers have asked the Health and Human Services inspector general to investigate so-called spread pricing practices by these pharmaceutical middlemen as part of a larger inquiry into rising drug costs.

In an April 8 letter released on Wednesday night, the heads of the Senate Finance Committee pointed to instances where PBMs have purportedly used this practice to make millions of dollars in excess profits at the expense of state Medicaid programs. Spread pricing is a crucial but little-known part of the opaque pharmaceutical pricing system and refers to fees PBMs pay pharmacies and bill back to Medicaid.

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  • Well Ed, I think these legislators are finally getting what Independent pharmacies have been dealing with for years.
    It’s really so easy to see yet no one saw it except independent pharmacists. How the folks at PCMA can sleep at night is beyond me. D.O.J needs to step in and do something about what PBM’s have grown into. You have one corporation that won’t show anyone their books or their pricing schedules.
    PBM’s have multiple MAC (Maximum Allowable Cost) price lists. There is no standardization in the industry as to the criteria for the inclusion of drugs on MAC lists or for the methodology as to how the PBM will determine the
    maximum price or how it’s changed or updated. PBMs have free reign on developing these methodologies and in
    turn, the ultimate price. The PBM’s client is left entirely in the dark. PBM’s pay pharmacies the low reimbursement
    MAC list and collect the high MAC price list. But no one can see this . This is the reason for lack of transparency !

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