Tag Archives: pharmacy benefits manager

Ohio Medicaid program demands new payment strategy after journalists explain how PBMs use ‘spread pricing’

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

Photo: afagen via Flickr

Over the past six months, journalists for the Columbus Dispatch have written more than 40 articles about the murky world of pharmacy benefit managers (PBMs) in Ohio. This week, they wrote one of the most important stories in this ongoing series, “Ohio firing pharmacy middlemen that cost taxpayers millions.”

In this article, they explained that the Ohio Department of Medicaid was changing the way it pays for prescription drugs by, “giving the boot to all pharmacy middlemen” because the Medicaid program wants to shift away from what’s called the “spread pricing” practice. Continue reading

Series on pharmacy benefit managers makes complicated topic easier to understand

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

Photo: Thomas Hawk via Flickr

One of the most complicated topics to cover in health care today is the role of pharmacy benefit managers (PBMs). Employers and health plans hire these middlemen to manage their prescription benefit programs for workers and health plan members.

Not only do PBMs contract with health plans, but some large health plans, notably UnitedHealthcare which owns Optum, have their own PBMs. Late last year, CVS Health, one of the nation’s largest retail pharmacy chains and owns Caremark, a PBM, said it would buy Aetna, one of the country’s largest health insurers. That deal is pending regulatory review, as Bruce Japsen reported for Forbes early this month. Continue reading

Reporters dig into pharmacy benefit concerns following merger announcements

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

Photo: Thomas Hawk via Flickr

The proposed combination of one of the nation’s largest health insurers, Cigna Corp., and the nation’s largest pharmacy benefits manager (PBM), Express Scripts Holdings Company, is unlikely to benefit consumers much, if at all. But to their credit, health care journalists are digging into how consumers might benefit from the deal.

These questions are important, given that the Cigna-Express Scripts deal follows an announcement three months earlier that CVS Health would pay $69 billion for Aetna Inc., another major health insurers, in a deal “that could reshape the health industry,” as the New York Times reported. Pharmacy retailer CVS Health also owns a PBM, CVS/Caremark. Continue reading