Why several states are investigating PBMs
At least seven states and the District of Columbia are investigating pharmacy benefit managers, focusing on whether the companies fully disclose the details of their business and whether they receive overpayments under state contracts, The Wall Street Journal reported May 11.
Ohio, Oklahoma, Georgia, New Mexico, Kansas, Arkansas and Mississippi and Washington D.C., are all investigating various PBMs, according to the offices of state attorneys general and auditors and public documents obtained by the Journal.
Among the companies being investigated are the PBM units of Centene, UnitedHealth Group and CVS Health.
Ohio Attorney General Dave Yost, who recently sued Centene for allegedly misleading the state’s Medicaid program about its pharmacy-related costs, told the Journal he expects a couple of new lawsuits filed by states against PBMs this summer and that “before this is all done, I will be surprised if we don’t have a dozen or more states” bringing complaints against PBMs.
Brian Colón, the Democratic auditor for New Mexico, told the Journal his office is investigating “drug-pricing practices for the managed care organizations and the pharmacy benefit managers” that serve the state’s Medicaid program and employee plan. They are looking at whether the PBMs are complying with their contracts and if the state has been overcharged.
A spokesperson for Arkansas’ attorney general told the Journal the state is “looking at PBMs associated with medical plans sponsored by the state of Arkansas.”
Representatives for attorney generals in Oklahoma and Kansas, as well as for Georgia Gov. Brian Kemp, all confirmed to the Journal investigations into PBMs. A spokesperson for the attorney general of Washington, D.C. declined to comment.
Several states have hired the same law firm, Liston & Deas, to investigate PBMs, according to publicly available contracts obtained by the Journal.
A recent filing with the U.S. Securities and Exchange Commission by CVS Health said the company was being investigated by the “attorneys general of several states, as well as the District of Columbia regarding its PBM practices, including pricing and rebates,” the Journal reported.
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