Audit Suggests PBM Drug Pricing Practices May Lead to Higher Health Care Costs

Ohio’s recent efforts to address pharmacy benefit manager (PBM) practices may have implications for further state and federal reform, according to a perspective published in the Journal of the American Medical Association.

PBMs have been the focus of increasing scrutiny as many blame their unregulated practices for contributing to increasing prescription drug costs. The perspective, which addresses several areas of concern and provides insight into PBM pricing practices, suggests that reform may lead to drug cost savings.

According to the authors, a 2018 independent audit examined the impact of Ohio Medicaid’s switch in 2011 from a fee-for-service model to a managed care model to administer its outpatient prescription drug benefits. To date, the Ohio audit is the first comprehensive review of PBM practices and incorporated 39 million drug transactions, the authors said.

Overall, the audit indicated that the switch to a managed care program, which uses PBMs, saved the Ohio Medicaid program $415 million annually. The savings were largely driven by the lower prescription claim prices billed to plans by PBMs, according to the report.

This article was originally published on Specialty Pharmacy Times.

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