State Medicaid programs, now in their second year of utilizing the federally mandated program to pay for Medicaid fee for service (FFS) prescription claims of an actual acquisition cost (AAC) for the drug ingredient (mostly federal NADAC pricing) and a survey-based, cost to dispense (COD) professional dispensing fee (PDF), are beginning the process this year to survey pharmacies of their Medicaid prescription dispensing costs to update their COD fee. Many states have state laws to require pharmacies to participate in these surveys which occur usually every two years.

We are in the final stages of the legislative process for AB 315 (Wood, Dahle, Nazarian & Stone) which would require that Pharmacy Benefit Managers (PBMs) be regulated by the California Department of Managed Health Care (DMHC). Voting will take place as early as Monday, August 27th.

IPC Chairman of the Board, Chris Darling, recently had a visit from Congressman Glenn Thompson!

OH Medicaid Orders All Ohio MCOs to Terminate PBMs Using Spread Pricing; Must Switch to Pass Through Pricing PBM Contracts. Creates Big Improvement Opportunity for MCO Pharmacy Reimbursement

Ohio Attorney General Mike DeWine is ramping up his investigation into the costly practices of pharmacy middlemen, hiring outside counsel to assist with a probe he expects to lead to litigation. The study said PBM fees should be in the range of 90 cents to $1.90 per prescription. CVS Caremark billed the state about $5.60 per script; Optum charged $6.50 — three to six times higher.

Anti-Prescription Clawback Fees and Pharmacy "Gag Orders" PBM Regulation Bill Passed the Ohio House of Representatives Unanimously! Next step is the Senate! HB 479 is now moving to the Senate for action. PBMs and insurers are working to water down the bill over in the Senate, so your activism in the next chapter is even more important than before. Please take the time to contact your Senator and urge them to support the bill's passage.