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Ohio Taxpayers Deserve a Balanced Story on Pharmacy Benefit Managers

December 21, 2018 | Pbm

Across our CVS Health enterprise, our goal is to help reduce overall health care costs and improve health outcomes. As part of that, CVS Caremark, our pharmacy benefit management (PBM) business, is committed to finding ways to lower drug costs for the payors and patients we support, including our Ohio Medicaid managed care clients. This is increasingly important as the list price of drugs continues to rise. CVS Health believes it is important that you have all the facts regarding our role as a PBM and the value we provide to the state. These facts are a critical part of the full story when it comes to the PBMs that help support Ohio Medicaid:

  • According to a report commissioned by the Ohio Department of Medicaid, PBMs have saved Ohio taxpayers $145 million annually by servicing the state’s Managed Medicaid plans, even as the drug prices set by the manufacturers have continued to rise.

  • Ohio’s Medicaid expenditure per prescription is more than 13% below the collective average cost of states that manage their own program versus using a PBM.

  • Government-mandated rebates in the Medicaid program are shared by the states and the Medicaid program. PBMs do not receive and, therefore, do not keep any of those mandated rebates. CVS Caremark also passes 100% of any negotiated supplemental rebates to our Ohio Managed Medicaid clients and do not keep any amount of drug manufacturer rebates for Medicaid prescriptions in Ohio.

  • Moving the Ohio Medicaid drug benefit to a fee-for-service model, and away from the current spread pricing model, would cost the State of Ohio more than $500 million over two years.According to a recent estimate by the Ohio Department of Medicaid

Additionally, recent reporting from the Columbus Dispatch has skewed important information. Learn more about how we’re Reimbursing Independent Pharmacies Fairly in Ohio.


Drug manufacturers alone set prices for prescription drugs

  • In just the first 7 months of 2018, prices had increased on more than 4,400 brand-name drugs.Source: Associated Press,

  • Prices for the top 10 drugs in the US have increased more than 100 percent since 2011.Source: Reuters,