The Columbus Dispatch - - Nation&world - Dis­patch Re­porter Jim Siegel con­trib­uted to this story. mschladen@dis­ @mar­tyschladen

Some law­mak­ers have been look­ing into whether “phar­macy-ben­e­fit man­agers” such as CVS Care­mark are us­ing a lack of trans­parency in pric­ing to take ad­van­tage of health plans and cus­tomers, in­clud­ing Med­i­caid, the fed­eral-state health pro­gram for the poor that serves more than 3 mil­lion Ohioans.

CVS of­fi­cials last week wouldn’t say whether the man­ager is re­im­burs­ing re­tail phar­ma­cies at one rate and then billing health plans for much more. Those rates, which come from “max­i­mum-al­low­able-cost” lists, aren’t avail­able to the pub­lic or to the health plans that con­tract with Ohio Med­i­caid.

Some man­aged-care ad­vo­cates point out that phar­macy-ben­e­fit man­agers use their size and so­phis­ti­ca­tion to ne­go­ti­ate lower prices from phar­ma­cists and drug man­u­fac­tur­ers that save cus­tomers money when com­pared with the

tra­di­tional fee-for-ser­vice model. But Rep. Kirk Schur­ing, R-Can­ton, the No. 2 House leader, ques­tioned whether the plans need to con­duct so much of their busi­ness in se­cret.

“It’s all about trans­parency, about be­ing able to as­cer­tain what is be­ing paid to the (phar­macy-ben­e­fit man­agers), what the ul­ti­mate sav­ings are for the pa­tients who re­ceive med­i­ca­tion through the PBMs,” he said Tues­day. “There seems to be a con­cern by some that they can’t con­nect the dots be­cause of a lack of trans­parency.”

Repub­li­cans are sched­uled to hold a 9 a.m. Wed­nes­day news con­fer­ence in which they say they will dis­cuss strate­gies. Repub­li­can state Au­di­tor Dave Yost, House Speaker Cliff Rosen­berger, R-Clarksville, Rep. Ryan Smith, R-Bidwell, Rep. Scott Lipps, R-Franklin, and other mem­bers of the House Repub­li­can Cau­cus are sched­uled to be there.

Chris­tine Cramer, a spokes­woman for CVS, said her com­pany is open to the process.

“We are a com­mit­ted, ma­jor em­ployer and busi­ness op­er­a­tor in Ohio and look for­ward to hav­ing an open dis­cus­sion with leg­isla­tive lead­ers on this and any other top­ics or con­cerns,” she said in an email. “We reg­u­larly make our­selves avail­able to the lead­er­ship in the leg­is­la­ture as a re­source and they know we are will­ing and ready to work with them.”

Lipps al­ready has filed a bill to end cer­tain clauses that some large phar­ma­cy­ben­e­fit man­agers re­quire in their con­tracts with phar­ma­cies. The clauses pro­hibit phar­ma­cists from telling cus­tomers that the cash price for a drug is cheaper than the in­sur­ance co­pay.

Cramer on Tues­day said CVS does not en­gage in the prac­tice.

Ohio is among sev­eral states to raise con­cerns about the be­hind-the-scenes in­flu­ence and prof­itabil­ity of phar­macy-ben­e­fit man­agers.

Ken­tucky law­mak­ers say their Med­i­caid pro­gram last year spent $1.68 bil­lion on pre­scrip­tion drugs, and phar­macy-ben­e­fit man­agers — in­clud­ing CVS — pock­eted $680 mil­lion of that amount, The As­so­ci­ated Press re­ported. One Ken­tucky state sen­a­tor, Tom Bu­ford, said he be­lieved that CVS also was us­ing its power as a phar­macy-ben­e­fit man­ager to drive out com­pe­ti­tion for its re­tail busi­ness.

Con­cerns also have been raised in Louisiana over the lack of trans­parency in con­tracts be­tween phar­macy-ben­e­fit man­agers and state Med­i­caid pro­grams.

And Bloomberg News re­ported this month that at the start of the year, CVS Care­mark cut its re­im­burse­ments to out­side phar­ma­cies while pay­ing more to its own.

Seven of the 26 states that have Med­i­caid man­aged care ad­min­is­ter phar­macy ben­e­fits them­selves. West Vir­ginia re­cently used an ad­min­is­tra­tive mea­sure to do so, and Ken­tucky is con­sid­er­ing leg­is­la­tion that would have a sim­i­lar ef­fect.

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