New Ohio drug pricing data from shows where PBMs and pharmacies make their money

Last week, we told you that CMS had updated their State Utilization databases, which provides quarterly updates that shows what state Medicaid programs are spending on prescription drugs. We ran through some of the highlights of what the new data showed, but we promised that we would be back this week to show highlight some of the incredible findings from the state of Ohio, which has become ground zero for drug pricing scrutiny, as the heads of United States Senate Finance Committee called for a federal investigation based on what has been discovered in our home state.

When we ripped open the newly-released data and examined CMS’ gift, we found some major changes in the way that the Buckeye State reported their data – and it has revealed some eye-opening information about PBM and pharmacy margins on prescription drugs.

Given all the drug pricing noise out of Ohio, the state Attorney General's hints that litigation is coming, and the federal heat on PBM “spread pricing,” we decided to do a deep dive into what’s happening in Ohio, and how its new data provides incredible clues to determine where the money flows within the drug supply chain.

The fortunate timing of the data reporting now gives us an unprecedented ability to see which drugs were targeted by PBMs for spread pricing, and which drugs are yielding healthy margins to pharmacies. It’s not perfect, but this is (to our knowledge) the first drug-level look at spread and pharmacy payments using exclusively public data.

In case you missed last week's report that highlighted key takeaways from CMS' latest State Utilization Data update, be sure to check it out here.