News Briefs: Ohio Touts Savings From Move to Single PBM
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Apr 24, 2025
Ohio’s decision to use just one PBM to serve its Medicaid population saved $333 million in administrative costs over two years, according to a state analysis. The state created its own single PBM (SPBM) in 2022 after ending its contract with CVS Health’s Caremark and UnitedHealth Group’s Optum Rx. The move to an SPBM garnered net savings of $140 million and paid $700 million to contracted pharmacies in dispensing fees. More than 99% of pharmacies in the state participate in the SPBM, which pays them $9 per prescription instead of the old average of 73 cents. “The SPBM has delivered much needed accountability and price transparency for Ohio taxpayers and Ohio pharmacies, providing assurance that Ohio’s tax dollars are spent appropriately,” according to the analysis.
Pharmaceutical companies are catching on to “alternative funders” and are further restricting who can access patient assistance programs (PAPs), Bloomberg reported, noting that patients can be caught in the middle and receive eye-popping bills for uncovered medications. Alternative funders are middlemen hired by employers who decide not to cover certain high-cost drugs through their health plans. The alternative funders, including companies such as Payer Matrix, find avenues for patients to obtain subsidized or free drugs, including through drugmaker PAPs created to help uninsured or underinsured patients. Drugmakers such as AbbVie Inc. have moved to bar patients using alternative funders to access their PAP because the companies steer insured patients to charitable care. In 2023, AbbVie sued Payer Matrix, claiming the action is “to stop Payer Matrix’s harmful conduct and protect its program so it can continue to serve its intended purpose — providing free drugs to uninsured and underinsured patients who otherwise could not afford their AbbVie medicine.”
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