Speaker Rosenberger, Auditor Yost Call for More Data Related to Managed Care Plans and PBM Industry

COLUMBUS—Today, Speaker of the Ohio House Clifford A. Rosenberger (R-Clarksville), State Representative Scott Lipps (R-Franklin) and other House members, along with State Auditor Dave Yost participated in a press conference to discuss efforts to update Ohio’s pharmacy benefit managers (PBM) industry.

Since the state’s managed care plans do not directly manage the pharmacy component of their healthcare systems, the majority of the plans are subcontracted out to single pharmacy benefit managers. However, today’s announcement shed light on the problem of not having specific data from the contracts between pharmacies and PBMs to understand the amount that is reimbursed to pharmacies in order to compare that amount against the amount paid to the PBM.

Because there is a lack of data on this issue, members today stressed the importance of working with the Department of Medicaid to retrieve the necessary data to ensure that PBMs are not inflating the costs, which eventually impacts the expenses billed to managed care plans, and ultimately Ohioans, when they buy medication. In collaboration with Auditor Yost, House members are pushing for more transparency and accountability in this part of Ohio’s managed care system.

“This is an issue that the House has been looking at for many years, and it’s our goal to build upon some of those efforts while also ensuring that we have the right kind of data to ensure transparency in the PBM industry,” Speaker Rosenberger said. “I want to thank Auditor Yost, Rep. Lipps, Chairman Smith, and my fellow House members who joined me today to continue Ohio’s charge in this area and to bring attention to finding a real solution to a problem that many local pharmacies are facing.”

“After talking with pharmacists in my district, I’m pleased to see this issue getting statewide and national attention,” said Rep. Lipps. “This is about transparency, taxpayer dollars, and access to data, and I look forward to working towards a solution that keeps local pharmacies open and keeps Ohio’s marketplace fair.”

“I continue to hear about this issue from local pharmacies in my district, and in other rural districts, which are highly dependent upon Medicaid reimbursements,” said Rep. Ryan Smith (R-Bidwell). “It is important for our small businesses to have the opportunity to compete and, even more importantly, that patients have access to care. As we move forward in looking at this issue, we need to have the information in front of us to know our next steps, and I applaud Speaker Rosenberger and Representative Lipps for taking action today.”

“My job is to protect the taxpayers and when 40 cents of every one dollar goes to Medicaid, transparency will create better policy and better decisions,” Auditor Yost said.

Click here to view today’s press conference: https://www.ohiochannel.org/video/press-conference-reforming-ohios-pharmacy-benefit-managers-industry.