The Texas Office of the Inspector General released several reports sharing findings of its audits of PBMs operating within the Medicaid Managed Care program. One audit found the PBM Navitus out of compliance with its combination of product reimbursement and dispensing fees, obscuring the amount it paid to pharmacies in Medicaid and the Children’s Health Insurance Programs. Meanwhile, audits of Caremark found that, in its service to Aetna and Wellpoint Medicaid plans, the company broke compliance by using effective rates that resulted in spread pricing, with massive funds not being passed back to the health plans. In turn, the health plans overrepresented drug expenditures in their reports to the Texas Health and Human Services Commission.
NCPA
