Spread Pricing: From Largely Unknown To Much Scrutinized and Criticized

Managed Care Magazine

After Ohio uncovered huge spreads, other states have taken a hard look at spread pricing in their Medicaid programs. U.S. senators and CMS are also getting into the act.

If some lawmakers have their way, PBMs will no longer be able to play the spread. A small but growing number of states are scrutinizing the role that PBMs play in their Medicaid programs amid reports that these middlemen are unfairly siphoning off profits. More recently, U.S. senators have taken up what seems to be a bipartisan cause. The ranking members of the Senate Finance Com-mittee have introduced a bill that would put an end to what is known as spread pricing in Medicaid programs throughout the country.
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“Drug payments should focus on the beneficiary, not the PBMs,” Sen. Charles Grassley, the Iowa Republican who chairs the committee, said last month. “Medicaid funding should go to patients, not the pockets of health care middlemen.”
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