Managed Care
State Medicaid Audit Reveals PBM Tactics That Inflate Drug Costs
A state Medicaid audit uncovered tactics pharmacy benefit managers use to obscure prescription drug costs, resulting in overcharges to taxpayers. The audit identified complicated claims processing methods that increased Medicaid spending beyond what would be expected under transparent pricing. The findings affect states contracting with PBMs directly or through managed care organizations for pharmacy services. The disclosure raises questions about PBM oversight requirements and potential recoupment of overpayments.
Why it mattersManaged care organizations contracting with PBMs for pharmacy services face increased scrutiny over drug pricing transparency and may need to strengthen contract language around claims adjudication and cost reporting.