Ohio officials expect that consolidating the seven private pharmacy benefit managers that run its Medicaid managed-care system into a single, state-regulated PBM will save more than $240 million every year. The change will go in effect starting in early 2022.
Officials will administer PBM services through Gainwell Technologies, a state-regulated PBM that will replace the seven PBMs currently operating in the managed-care system. A pharmacy pricing and audit consultant will help state officials make decisions with regard to in-network providers, pharmacy reimbursement and more.
Ohio Department of Medicaid Director Maureen Corcoran declined to name the consultant working with Ohio.
“There’s too much about the PBM world that is not transparent,” she said. “There’s too many opportunities for conflicts of interest. There’s too many opportunities for decisions to be made based on profit, and rebate amounts, and things like that, rather than the best interest of the consumer.”
The state is