Vetoes by Dewine get mixed reviews
Many of Gov. Mike Dewine's 25 budget vetoes had to do with sweeping reforms to the pharmacy middlemen serving the state's Medicaid system, but the governor insisted that he remains committed to efforts to overhaul the costly setup blamed for gouging both Ohio pharmacies and taxpayers.
Still, Dewine's actions were greeted with a mixed reception Thursday.
The issue of reforming the middlemen, known as pharmacy benefit managers, has been a hot one since early last year, when investigations by The Dispatch and state officials revealed a system that was paying the PBMS almost a quarter-billion dollars more a year than it was reimbursing pharmacists for Medicaid drugs.
Lawmakers and incoming Gov. Dewine proposed this year a flurry of changes in an attempt to address concerns that pharmacies with a high proportion of Medicaid patients were being driven out of business. Some of those visions clashed Thursday.
In the wake of vetoing parts of the legislators' plan to rein in PBMS, one key lawmaker said the problem is now up to the administration to resolve.
“Clearly they own this; the Medicaid director owns this. The General Assembly is putting proposals on the table and has been clearly rebuffed,” said Sen. Dave Burke,a Marysville pharmacist who has pushed to hold pharmacy middlemen accountable.
“This leaves no policy. They’ve just left a big vacuum. Flexibility is not a policy.”
In a prepared statement, House Speaker Larry Householder said, “We are still reviewing the details of the governor’s vetoes, including those related to the pharmacy benefit managers, to ensure we fully understand the practical effects. We are pleased Gov. Dewine has endorsed our plan for a single PBM, which as you know we believe is an important reform for the state of Ohio.”
But at a Thursday afternoon news conference, Dewine insisted that he remains committed to the legislature’s plan and only vetoed provisions he believed were too restrictive and would make it difficult for his administration to enact.
That includes moving to a single pharmacy benefit manager “as soon as we can.”
“We vetoed some of the language, prescriptive language,” Dewine said. “But, we accepted the will of the legislature to go with a single PBM. My (Medicaid) director says she can certainly work with that.”
Rep. Scott Lipps, R-franklin, who also has pushed for sweeping changes, said he supports the governor’s approach and is confident that lawmakers and the administration are on the same page.
“He’s going to do this through administrative change. If you (put it into law) and you get it wrong, you’re stuck with it,” Lipps said. “This will still make Ohio a national leader in PBM reform.”
In an earlier statement explaining many of the Pbm-related vetoes, Dewine said that he wanted to preserve the flexibility of the Ohio Department of Medicaid to manage reforms
to a program that spends $2.5 billion on drugs each year through managed care. For example, Dewine vetoed a budget provision that would have required the Medicaid department to directly hire a single pharmacy benefit manager rather than dealing indirectly with PBMS through five managed-care plans.
“The Department of Medicaid is willing to proceed with the provisions that achieve the legislature’s goal of a single Medicaid pharmacy benefit manager, but the department requires flexibility to implement this goal successfully,” the veto message said. “Additionally, contained in this section are provisions that allow the pharmacy benefit manager to shield non-confidential and non-proprietary information inappropriately and limit transparency that Ohioans deserve.”
Antonio Ciaccia, spokesman for the Ohio Pharmacists
Association, said he doesn’t take issue with Dewine preserving Medicaid officials’ flexibility in moving to a single PBM. Ciaccia added that lawmakers likely didn’t intend it, but the budget as written would have allowed the state PBM to prohibit the Medicaid department from disclosing information to lawmakers and the public simply by labeling it “confidential” or “proprietary.” Many have blamed the state’s current problems with PBMS on a lack of transparency.
“I would agree that this veto is a good veto,” Ciaccia said. “It’s more disclosure.”
Dewine also vetoed a provision to require the Medicaid director to work in conjunction with the PBM to establish a single formulary — a list of drugs that Medicaid will cover and how much the state will pay for them. Ciaccia noted that Director Maureen Corcoran is already working on such a list and
questioned whether PBMS, which currently have control over formularies, should be inserted into the process.
Ciaccia reserved his strongest reservations for Dewine’s veto of budget provisions governing how $100 million in supplemental funds will be paid to pharmacists. The rules spelled out that those with the heaviest load of Medicaid patients would have gotten the biggest share of that money. They also would have prohibited the PBM from cutting reimbursements to pharmacies that received supplemental payments.
“It’s going to require some vigilance to make sure that this money is going to the communities that need it the most,” Ciaccia said. “Now it’s incumbent on the administration to do that.”