Ohio Attorney General Dave Yost has launched an investigation into an obscure drug-pricing maneuver that could be both illegal and costing taxpayers millions of dollars.
Yost’s top assistant for health and human services issues, Ara Mekhjian, sent a series of “investigative requests” seeking information for a probe of pharmacy benefit managers — controversial middlemen in the drug supply chain. The communiques to Medicaid managed care organizations were obtained by The Dispatch through a public records request.
The probe targets the three PBMs that dominate 80% of the business nationally: CVS Caremark, Express Scripts and Optum. All are part of conglomerates that are among the 15 largest companies in America.
The investigation centers on “clawbacks” — PBM charges to pharmacies that occur well after a Medicaid patient’s prescription is filled and supposedly paid for. Since those additional assessments occur weeks and sometimes months after the transaction, they are not recorded by the Ohio Department of Medicaid, Director Maureen Corcoran has acknowledged.
Taxpayers possibly being overcharged by millions of dollars
The inability of the state to track millions of dollars of prescription payments for Ohio’s disabled and poorest residents represents much more than a paperwork error.
First, it means that the state reports inflated cost figures to the Centers for Medicare & Medicaid Services. Since PBM clawbacks happen across the country and not just in Ohio, that presumably means the federal agency’s key database is corrupted.
