Court Tells Ohio Medicaid, CVS Caremark To Agree On Redactions In Report On PBM Fees

Jul 17, 2018

It’ll be at least a week before the state will release a full report it commissioned on how much it’s paying its pharmacy benefit managers compared to how much those PBMs are paying out to pharmacies for drugs for Medicaid recipients.

An executive summary of the report shows the state paid CVS Caremark and its other PBM, Optum, nearly 9 percent more for drugs for Medicaid recipients than those middlemen paid out to pharmacies. That adds up to almost $224 million. And the summary shows those fees are three times what is industry standard for CVS Caremark, and even higher for Optum.

Just hours before the report was to be released, CVS Caremark sued, saying it contains proprietary information that would be devastating to its entire business model. But after initially holding back the full report, Medicaid says it’s in the best interest of the public that it’s released. A Franklin County judge told Medicaid and CVS Caremark to agree on what should be blacked out in the report, and come back to court next week.