A dozen Ohio professional groups on Monday announced an effort force greater accountability from powerful prescription drug middlemen known as pharmacy benefit managers, or PBMs.
The PBM Accountability Project of Ohio is intended to educate policymakers and the public about problems involving PBMs and work on policies to address them.
“Lawmakers and administration officials in Ohio have been addressing the role of PBMs and we encourage the incoming General Assembly to continue this work,” Ernie Boyd, Executive Director of the Ohio Pharmacists Association, said in a statement. “The PBM Accountability Project will provide a platform for more perspectives on how PBM practices impact patients and providers and why reform is necessary.”
For the past several years, pharmacists and other medical practitioners have been pointing to problems in the highly concentrated PBM marketplace.
The companies contract with payors such as Medicaid and insurance companies. On their behalf, PBMs reconcile claims for prescription drugs, determine reimbursements to pharmacies, create lists of preferred drugs and negotiate rebates from drug manufacturers.
More than 70% of the $400 billion-a-year marketplace is controlled by three companies: CVS Caremark, Express Scripts and OptumRx. Critics of the companies say they operate behind a veil of secrecy to under-reimburse pharmacies that they’re often in direct competition with and pocket an unfair share of the massive rebates they get from drugmakers.
In 2018, the Ohio Department of Medicaid commissioned an analysis that found that in 2017 CVS Caremark and OptumRx billed the state almost a quarter-billion dollars more for generic drugs than it paid to the pharmacies that dispensed them.
In response, the Medicaid department and the General Assembly have worked on a number of reforms and Attorney General Dave Yost has sued OptumRx on behalf of the Bureau of Workers’ Compensation while promising that suits on behalf of other state agencies are coming.
The effort announced Monday seeks to maintain that momentum.
“The PBM Accountability Project will be part of the next phase of developing public policy that guides our drug supply chain in Ohio,” said Dave Dillahunt, Executive Director of the Ohio Hematology Oncology Society. “Meaningful work is underway to address how PBMs are taking advantage of their position at the expense of patients, providers and employers. It’s time for more patient advocates to join the effort and share how reforms will help improve access and affordability for cancer patients.”
In addition to Boyd’s and Dillahunt’s organizations, many others have signed on to the effort, including: the Academy of Medicine of Cleveland and Northern Ohio, Charitable Healthcare Network of Ohio, Easterseals of Central and Southeast Ohio, Mental Health America of Ohio, National Alliance on Mental Illness of Ohio, Ohio Bleeding Disorders Council, Ohio Psychological Association, Ohio Osteopathic Association, Ohio Sickle Cell and Health Association, and the Ohio State Grange.