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State Says It's Pleased With its Audit of Pharmacy Benefit Managers for Now

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. Statehouse correspondent Karen Kasler reports 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 says the $225 million dollar differential sounds like a lot, but that it would cost the state a lot to do what the PBMs 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 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. 

Karen is a lifelong Ohioan who has served as news director at WCBE-FM, assignment editor/overnight anchor at WBNS-TV, and afternoon drive anchor/assignment editor in WTAM-AM in Cleveland. In addition to her daily reporting for Ohio’s public radio stations, she’s reported for NPR, the BBC, ABC Radio News and other news outlets. She hosts and produces the Statehouse News Bureau’s weekly TV show “The State of Ohio”, which airs on PBS stations statewide. She’s also a frequent guest on WOSU TV’s “Columbus on the Record”, a regular panelist on “The Sound of Ideas” on ideastream in Cleveland, appeared on the inaugural edition of “Face the State” on WBNS-TV and occasionally reports for “PBS Newshour”. She’s often called to moderate debates, including the Columbus Metropolitan Club’s Issue 3/legal marijuana debate and its pre-primary mayoral debate, and the City Club of Cleveland’s US Senate debate in 2012.