PBM Abuses in Ohio Gets Media Scrutiny for Hurting Patients

Aug 17, 2016

IPC is Working in Ohio to Strengthen PBM Regulation; Member Pharmacies Can Take Action By Filing Complaint Forms

Two recent TV investigative reports by WBNS-10TV in Columbus, Ohio have focused on Pharmacy Benefits Manager (PBM) abuses.  This expose shows how PBM manipulate drug prices and payments that not only hurt pharmacies, but cost patients more money in their out of pocket. The result of this is increased coverage costs and a reduction of successful patient outcomes.

The Ohio Pharmacist Association (OPA) was interviewed for these WBNS-10TV stories, which can be found here:  Part 1; Part 2. OPA has been a tremendous partner for IPC in achieving legislative success on securing in 2015 a comprehensive Maximum Allowable Cost (MAC) law (as part of HB 64). You can read IPC’s report on that law here.

Together we have been pushing the Ohio Insurance Division (OID) to enforce this legislation. As a result of these efforts OID developed a complaint form and guide (guide and FAQ can be found here) for pharmacies to use in filings complaints of PBMs not updating their MAC prices, acting on appeals or placing conditions, limits or penalties on pharmacies or their Pharmacy Services Administrative Organization (PSAO). OID is even taking the position that this law, and the appeals process, applies to the Express Scripts’ AWP based generic reimbursement approach. 

If you have not yet filed complaints with the OID of PBM generic reimbursement non-updates and appeals denials, please do so as soon as possible. Make sure you or your PSAO documents the PBMs’ handling of the appeal. The more appeals that are filed about the non-compliance of PBMs with Ohio’s MAC law, the more evidence OID will have to take action and the greater support it builds for the state legislature to pass even tougher laws regulating PBM activities.

Check back to IPC’s State Government Relations Updates page for further updates.

Questions or Concerns? Contact IPC’s Government Relations Team at: GovernmentRelations@ipcrx.com.