Pennsylvania is one of a number of states looking the operations and profits of pharmacy benefits managers employed by managed care plans that serve the state’s Medicaid population.
One state has already passed a law governing PBMs and others are doing the same as states zero in on how PBMs make their money when serving a Medicaid population whose care is paid for with public money.
One specific target is PBM’s “spread”: the suggestion that in addition to the fees they are paid by managed care organizations, PBMs charge managed care plans more than they pay pharmacies that dispense prescriptions and keep the difference for themselves as profit. Pennsylvania’s Department of Human Services, its auditor general, and the state Senate have all begun examining PBM operations in recent months to learn more about how PBMs make their money and whether they are doing so inappropriately at the expense of state taxpayers.
For a closer look at what PBMs are, the “spread” issue, and what officials in Pennsylvania and elsewhere are doing to get a better handle on this matter, see this Philadelphia Inquirer article.