The Oregon Health Authority released its audit of the state of its Medicaid managed care program this month, and unsurprisingly the findings were problematic. You can read it in full here, but here are the highlights:
For one, Oregon’s regulation of PBMs is limited and fragmented. The audit pointed to success in other states which provided patient protections, transparency and limited unfair practices that disproportionately impact community pharmacies. Pharmacy reimbursements have also varied greatly depending on the pharmacy, calling into question consistency across the program. In some cases, national chains—some owned by PBMs or PBM parent companies—were reimbursed twice the amount of independent pharmacies for the same prescriptions. Finally, while the Oregon Medicaid program has improved some of the coordinated care organizations contract language, the agency does not ensure sufficient transparency and compliance by PBMs.
The audit recommended the state enact legislation that focuses on patient and pharmacy protections and increasing transparency in the prescription drug supply chain. The outcome of this audit is similar to the Medicaid audits in numerous states, and it underscores the importance of Congress passing meaningful Medicaid managed care reform which prohibits spread pricing, provides increased transparency, and ensures fair pharmacy reimbursement in all state Medicaid managed care program.
