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PBM trade group raises concerns about Ohio's single‑PBM Medicaid model and costs
Summary
The Pharmaceutical Care Management Association told the subcommittee that Ohio's single‑PBM model (SPBM) has not produced measurable savings and that first‑year increases in net drug spending merit further review.
Shawn Stevenson of the Pharmaceutical Care Management Association (PCMA), a national pharmacy benefit manager trade association, testified that Ohio's transition to a single PBM model (SPBM) for Medicaid did not show evidence of savings in published analyses and urged the committee to scrutinize pharmacy administration choices.
Stevenson cited an Ohio Department of Medicaid memo and a Milliman analysis that, he said, found no material difference in expenditures under the SPBM versus prior MMC program modeling. He referenced federal MACPAC data showing the state spent roughly $600 million more on drugs, collected $400 million less in rebates, processed over 1 million fewer prescriptions, and filled a higher share of low‑cost generics after the transition year — figures PCMA said warrant further explanation.
PCMA also said a mandatory dispensing fee increase contributed to higher net spending and pointed to West Virginia experience in which dispensing‑fee policy increased commercial market costs. He recommended further evaluation to ensure the state is leveraging PBMs effectively while maintaining oversight and accountability.
Committee members were briefed on the concerns; no formal motions were made during the informal hearing.
