Newspaper Calls on Lawmakers To End PBM Pricing Scheme

Charges that CVS Caremark gouges purchasers

An editorial in the Columbus Dispatch of Ohio takes off the gloves when it comes to how PBMs do business. The editorial is a companion to investigative reporting by the newspaper concerning how CVS Caremark goes about its business saying that “for its middleman role in Ohio’s taxpayer-funded Medicaid prescription business, pharmacy benefit manager CVS Caremark takes home a substantial cut of the taxpayer dollars involved.”

There’s a wide gap between what PBMs charge insurers, even public insurers like Medicaid, and what they charge pharmacies. Just one example, take the drug Vyvanse for ADHD. Members in Medicaid managed care plans in Ohio are charged $8.64 per pill, but the PBM only paid 67 cents per pill.

“The Ohio Department of Medicaid is conducting its own analysis of pricing by PBMs,” the editorial concludes. “It should share the results as soon as possible and work with the General Assembly to fix a system that clearly isn’t working.”