Ohio officials defend single PBM after three years of implementation; state, vendor and outside reviewers cite savings and operational challenges

Chairman Holmes opened the Joint Medicaid Oversight Committee meeting by framing a multi-panel discussion of Ohio’s single pharmacy benefit manager program and invited Ohio Department of Medicaid officials and independent experts to summarize implementation, performance and lessons learned.

Director Corcoran, director of the Ohio Department of Medicaid, said the single PBM contract covers all Medicaid beneficiaries and nearly all Ohio pharmacies, and that the program was designed to reduce conflicts of interest, end spread pricing and increase transparency. "We now pay pharmacies a fair rate for the acquisition of drugs using a survey based tool that looks specifically at what Ohio pharmacies pay to acquire medications," Director Corcoran said.

The nut graf: Committee testimony and independent reviews presented three types of findings — operational problems during rollout that were subsequently mitigated, measured increases in pharmacy reimbursements and supplemental rebates, and differing fiscal estimates about net savings depending on modeling assumptions. The department and its contractors said the program improved provider relations and pricing transparency; an independent actuary found savings were modest under its baseline scenario.

Sean Eckert, pharmacy director for the Ohio Department of Medicaid, described the program’s procurement and implementation timeline and identified…