Kentucky, Ohio Actions Bring Greater Transparency on Medicaid Reimbursements

Apr 18, 2018
The National Community Pharmacists Association (NCPA) issued a press release on recent efforts in Kentucky and Ohio to bring transparency to the states' Medicaid managed care programs and assure taxpayer funds are being used appropriately. Excerpt below, view the full news release here.

NCPA News Release on Kentucky, Ohio Actions

The Kentucky legislature recently enacted Senate Bill 5, which establishes disclosure and contract requirements for pharmacy benefit managers - the entities that contract with managed care organizations to administer Medicaid prescription drug benefits. PBMs control pharmacy payments and determine consumer costs of prescription medications. Under the Kentucky bill, a PBM must make certain disclosures, including the amount paid by the MCO to the PBM and the portion of that amount that is subsequently paid to pharmacies. The bill also gives the Department of Medicaid Services the authority to set reimbursement rates between a PBM and a contracted pharmacy, thus ensuring pharmacies are reimbursed fairly. The bill was introduced by Senator Max Wise (R-KY).

In Ohio, state Medicaid officials have announced plans to investigate claims that PBMs are increasing Medicaid costs by charging the state more for prescription claims than they are reimbursing pharmacies for filling the prescriptions. If the allegations are true, the state is prepared to hand down sanctions. The state Medicaid agency has asked all five managed care companies that contract with the state Medicaid program to provide data showing how much they paid their PBMs and how much the PBMs paid pharmacies to fill prescriptions during a 12-month period ending March 31.

Read the full press release on NCPA's website