Pharmacy benefit managers

photo of governor Mike DeWine
JO INGLES / STATEHOUSE NEWS BUREAU

Many of Gov. Mike DeWine’s 25 budget vetoes had to do with changes to Ohio’s Medicaid system. And part of that involves the two pharmacy benefit managers, or PBMs, the state uses as middlemen between Medicaid and pharmacists. The budget tries to rein in overspending on prescription drugs by moving to one single state-controlled PBM.

Photo of Dave Yost
ANDY CHOW / STATEHOUSE NEWS BUREAU

Ohio’s attorney general wants lawmakers to make changes to the way the state deals with pharmacy benefit managers (PBMs). Those are the private companies that handle prescription drug buys for its current and retired employees, Medicaid recipients and the workers’ compensation system. 

Dave Yost wants one centralized state contract with all PBMs. He said that should eliminate the secrecy that he thinks has allowed PBMs to overcharge the state.

“Just as a guess, I’m thinking certainly tens of millions of dollars are on the table here," Yost said.

photo of Dave Yost
ANDY CHOW / STATEHOUSE NEWS BUREAU

Ohio’s attorney general says one of the prescription drug middlemen working with the Bureau of Workers Compensation took millions of dollars in overpayments that rightfully belong the state. 

Ohio Department of Medicaid
STATE OF OHIO

It’ll be at least a week before the state will release a full report it commissioned on how much it’s paying its pharmacy benefit managers compared with how much those pharmacy benefit managers are paying out to pharmacies for drugs for Medicaid recipients.

Photo of pills
SHUTTERSTOCK.COM

Ohioans who go to the pharmacy to pick up prescriptions sometimes pay more out of pocket with their insurance card than they would if they didn’t have coverage. However, state regulators are trying to ensure Ohioans pay the least possible. 

The Ohio Department of Insurance’s Jillian Froment says sometimes pharmacists don’t disclose potential cost savings because of what’s often called a “gag order.”