Ohio must demand transparency

The more we learn about the operations of pharmacy benefit managers, the worse their greedy scheming is revealed to be.

PBMs, as they are known, were once hailed as an answer to provide needed cost controls through claims management for insurers and payers including Medicaid. But as their middleman role between prescription-drug manufacturers and payers has grown, they have been revealed as lining their pockets on both ends of the equation.

It’s a national disgrace, and continuing coverage by Dispatch reporters has raised the national understanding of how far this complex system has strayed from its intended responsibility.

Thankfully beginning Sunday, self-dealing practices of two of the nation’s largest PBMs, CVS Caremark and Optum Rx, will be easier to identify as new state contracts take effect requiring transparency in their operations.

Regulations for disclosing what the PBMs keep as well as what they are paid were imposed for the state’s July 1 new fiscal year by the Ohio Department of Medicaid in contracts with CVS Caremark and Optum RX, which handle prescriptions for the state’s five Medicaid managed-care programs. CVS Caremark is the PBM for four of the five.

And in a hearing on Thursday, the Ohio General Assembly’s Joint Medicaid Oversight Committee demanded a better deal from PBMs handling prescriptions in the tax-funded health-insurance program for 3 million poor and disabled Ohioans.

With frustration obviously fueled by Dispatch reports, some of the five senators and five representatives on the committee questioned the competence of Medicaid administrators who have declined to criticize PBM payments even