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Lawmakers Explore Billing Practices Of CVS Caremark, Optum Rx


State lawmakers want more information about the billing practices of companies that handle prescription drug benefits for millions of Medicaid recipients in Ohio. That's because they’re being accused of using the pharmacies they operate to drive smaller pharmacies out of business.

The allegation is that the two pharmacy benefit managers, or PBMs, hired by the state’s five Medicaid managed care plans have been reimbursing independent pharmacies at lower rates than they pay to the pharmacies affiliated with the PBMs.

Republican Rep. Scott Lipps of Franklin in southwest Ohio said small pharmacies are reporting an up to 80 percent drop in what Medicaid has been paying.

“The result, a net loss of 160 community pharmacies in Ohio in just over two years,” Lipps said.

State lawmakers say they want more transparency on prices and reimbursements paid by the two PBMs, CVS Caremark and Optum Rx. CVS has denied the accusation, saying there are strict firewalls that prevent this.