Ohio firing their Medicaid PBM

[samuricool]

Four of them are operated by CVS. The other is Optum.

http://gatehousenews.com/sideeffect...en-cost-taxpayers-millions/site/dispatch.com/


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[TheMadPharmacist]

Great job Ohio.

 

[maria1oh]

The ohio medicaid plan managed by optum is not accepted at cvs. Wonder if this will soon change.

 

[Sine Cura]

Why does any state need five managed Medicaid plans?

In some California counties there are SIX managed Medicaid plans (including Kaiser)? What are the PBMs? ESI, Caremark, Caremark, Optum, Caremark. Absurd.

 

[ValeRx]

Here in Ohio, they advertise the different Medicaid plans on radio and billboards. I feel like that shouldn't be allowed.

 

[maria1oh]

Population of los angeles county is about the same as entire state of ohio.

 

[Sine Cura]

Even LA County is a two-plan county.

 

[WVUPharm2007]

Why does any state need five managed Medicaid plans?

In some California counties there are SIX managed Medicaid plans (including Kaiser)? What are the PBMs? ESI, Caremark, Caremark, Optum, Caremark. Absurd.

Just the Philly metro has four. Aetna, Health Partners, United Healthcare, and Keystone First. Oddly, though, as far as I can tell, they all manage prescriptions themselves. You can tell. If you have a problem on the weekend with Keystone First, they literally will not take your phone call if you are a pharmacist. You will get sent to a mailbox that doesn't work and hangs up on you. If you actually finagle the system and make it to a human, they will just tell you that you need to call back on Monday. They won't give a single damn what it's about, either. It's sort of hilarious.

 

[PharFromNormal]

Just the Philly metro has four. Aetna, Health Partners, United Healthcare, and Keystone First. Oddly, though, as far as I can tell, they all manage prescriptions themselves. You can tell. If you have a problem on the weekend with Keystone First, they literally will not take your phone call if you are a pharmacist. You will get sent to a mailbox that doesn't work and hangs up on you. If you actually finagle the system and make it to a human, they will just tell you that you need to call back on Monday. They won't give a single damn what it's about, either. It's sort of hilarious.

Maybe Keystone First (or their contracted pbm entity) has a smaller spread than in Ohio and they don’t charge a seperate admin fee specific to this. Maybe they have nothing or little to spend on a highly functioning, highly accessible, highly staffed pharmacy help desk?
Or they suck.
Or both.

 

[maria1oh]

Caremark will not do lost med override with ohio medicaid plans. They transfer you to the plan and the plans are usually only there mon-fri 9-5. If caresource ohio medicaid member needs lost med over ride on weekend they are screwed.

 

[pencilandpen]

They are not "fired". The pbms will still have their businesses just the contract will be re negotiate so that they will be paid a flat admin fee.

 

[genesis09]

Wisconsin does have managed Medicaid plans. However, they do all prescriptions coverage in house. They do their own fomulary and you can find the meeting notes posted online.

 

[samuricool]

They are not "fired". The pbms will still have their businesses just the contract will be re negotiate so that they will be paid a flat admin fee.

Yup i understand that. Just using the same word that the article used.

They say they may use them to renegotiate for the pass through model (i think I’m using that terminology correctly). I wish they would just stop business with them altogether. But they are a standard in the industry so I find it hard to believe that they would just cut all ties.

Local pharmacist association continues to show some huge price spreads especially among specialty drugs. Caremark is so crooked it’s ridiculous - I know nothing new here.

Ohio Auditor of State Dave Yost

This article shows a more detailed breakdown of their recent findings. Pretty interesting stuff.

Edit: added the last two sentences for clarification of why the link was posted.


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[BidingMyTime]

Why does any state need five managed Medicaid plans?
In some California counties there are SIX managed Medicaid plans (including Kaiser)? What are the PBMs? ESI, Caremark, Caremark, Optum, Caremark. Absurd.

Illinois has like 6 or 7 managed Medicaid plans. Maybe someone gets big kick-backs for getting plan added to the state? I can't keep track of them all.

 

[Sine Cura]

I will point out that in some California counties managed care is overseen by commercial entities like UHC, Aetna, Anthem, whereas in most other counties the managed care plans are non-profit or publicly operated. All of them do contract with PBMs AFAIK if only for claims processing.

 

[PharBeyondDriven]

Many PBM's are just thinly veiled organized crime organizations.