EDITORIAL

PBMs’ work at about $43 million — less than a fifth of the $224 million they actually took in.

Granted, whoever administers the prescription-drug program for Medicaid’s managed-care plans must be able to pay staff and other administrative costs. But the amount of the spread kept by the PBMs — somewhere between 8.8 percent shown in the state audit and 12-percent in an earlier analysis by the Dispatch — seem well beyond what is needed for a reasonable profit.

Legislators are not the only ones concerned that Ohio’s Medicaid PBMs are out of control. Separately, State Auditor Dave Yost and Attorney General Mike DeWine, both Republicans, have announced their offices are investigating the middlemen’s practices as a result of the Dispatch reports.

PBMs have also become an issue in November elections, with promises to manage the situation better coming from Democrat Richard Cordray, who is running against DeWine for governor; former U.S. Attorney Steve Dettelbach, the Democratic candidate opposing Yost for attorney general, and both candidates for state auditor, Republican State Rep. Keith Faber and former U.S. Rep. Zack Space, a Democrat.

Part of the concern with operations of CVS Caremark has been that it underpaid pharmacies for filling Medicaid prescriptions — sometimes failing to even cover pharmacies’ costs for certain drugs. But being under multiple microscopes for its practices did not keep the PBM from raising fees it charges pharmacists for transactions including filling prescriptions, checking costs and eligibility and other electronic communications. The 21-percent increase from 14 cents to 17 cents each could amount to another $1 million for the company.

And concerns have been raised nationally about the timing of cuts CVS Caremark imposed on pharmacies in Ohio and elsewhere — coming within a few months of when its parent, CVS Health, announced it was acquiring Aetna, the nation’s third-largest health insurer. That deal was announced in December and is expected to close later this year.

CVS Caremark has defended its practices and price spread as reasonable.

For as complex as PBM operations are, one thing is simple: Medicaid administrators, legislators, office holders and would-be office holders must continue demanding more transparency until we can all be assured that consumers and taxpayers are being treated fairly. So far, that has been far from certain.