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Judge Tells CVS Caremark and Medicaid to Agree on Pharmacy Benefit Manager Report Redactions

Ohio Department of Medicaid
STATE OF OHIO
CVS Caremark sued hours before the report was to be released to the public, saying it would be detrimental to its business model.

It’ll be at least a week before the state will release a full report it commissioned on how much it’s paying its pharmacy benefit managers compared with how much those pharmacy benefit managers are paying out to pharmacies for drugs for Medicaid recipients.

An executive summary of the report shows the state paid CVS Caremark and its other pharmacy benefit manager, Optum, nearly 9 percent more for drugs for Medicaid recipients than those middlemen paid out to pharmacies. 

That adds up to almost $224 million. And the summary shows those fees are three times what is industry standard for CVS Caremark and even higher for Optum.

Just hours before the report was to be released, CVS Caremark sued, saying the report contains proprietary information that would be devastating to its entire business model. But after initially holding back the full report, Medicaid said it’s in the best interest of the public that it’s released.

A Franklin County judge told Medicaid and CVS Caremark to agree on what should be blacked out in the report and come back to court next week.

Karen is a lifelong Ohioan who has served as news director at WCBE-FM, assignment editor/overnight anchor at WBNS-TV, and afternoon drive anchor/assignment editor in WTAM-AM in Cleveland. In addition to her daily reporting for Ohio’s public radio stations, she’s reported for NPR, the BBC, ABC Radio News and other news outlets. She hosts and produces the Statehouse News Bureau’s weekly TV show “The State of Ohio”, which airs on PBS stations statewide. She’s also a frequent guest on WOSU TV’s “Columbus on the Record”, a regular panelist on “The Sound of Ideas” on ideastream in Cleveland, appeared on the inaugural edition of “Face the State” on WBNS-TV and occasionally reports for “PBS Newshour”. She’s often called to moderate debates, including the Columbus Metropolitan Club’s Issue 3/legal marijuana debate and its pre-primary mayoral debate, and the City Club of Cleveland’s US Senate debate in 2012.