As angst rises over the prices paid for medicines, a new analysis finds some pharmacy benefit managers that contract with Medicaid managed care organizations in Florida are pushing prescriptions to drugstore chains they control, raising costs for consumers and taxpayers.
The report, which analyzed approximately 350 million state Medicaid pharmacy claims from 2012 through 2019, noted that PBMs sometimes reimbursed their own pharmacies for certain medicines at substantially higher rates than what other drug stores received, and payments to their affiliated pharmacies greatly exceeded the cost to dispense the drugs.
One company singled out was CVS Health (CVS), which runs more than 9,900 pharmacies in the U.S. and one of the largest PBMs, which is called Caremark. As an example, Caremark paid small pharmacies and the Publix supermarket chain at or below 50 cents a pill for generic Abilify, which is used to treat schizophrenia and bipolar disorder. However, CVS pharmacies were paid $11.18, according to the report.
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