PUTT CALLS ON VIRGINIA’S DEPARTMENT OF MEDICAL ASSISTANCE SERVICES TO RELEASE RECENTLY-DELIVERED PHARMACY BENEFITS MANAGER AUDIT REPORT
WINSTON-SALEM, NC (November 13, 2018) -- Pharmacists United for Truth and Transparency (PUTT) is disappointed to learn that Virginia’s Department of Medical Assistance (DMAS) is shielding information collected from the Managed Care Organization (MCO) and Pharmacy Benefit Manager (PBM) audit report, which was undertaken for accountability to the Commonwealth of this taxpayer funded program. PUTT calls upon DMAS to act in the interest of transparency by releasing the report’s findings immediately.
A similar report this summer in Ohio, which found taxpayers were paying an estimated $225 million to PBMs over and above the cost of Medicaid-sponsored prescriptions led to the recall of PBM contracts in that state. Reports from independent pharmacists in Arkansas and Pennsylvania led to investigations by the state’s attorney general and auditor general respectively. The $1.5 million fine assessed by the State of Kentucky for 454 reimbursement violations and 38 violations related to providing inconsistent or inaccurate information to the state’s Department of Insurance point to signs that PBMs act not in the interest of patients and taxpayers, but in their own interest.
PBMs market themselves as negotiators and cost-savers, and in so doing position themselves in the minds of their clients as fiduciaries. Yet they are not fiduciaries - they are self-interested maximizers hiding behind excuses of “proprietary trade secrets” to avoid disclosing abominable practices that overcharge the very clients and patients they claim to protect while squeezing pharmacies with unsustainably low reimbursements and pushing many community pharmacies to the brink of closure.
The solution to the problem of high prescription costs starts with holding PBMs accountable and demanding they disclose their shady, closed-door practices. Reports such as these PBM audit findings are only the entry point to this level of transparency and accountability. The public has more than paid the price for this report, Virginia’s consumers and taxpayers should be allowed to review the results.
PUTT respectfully asks DMAS to share the findings of the PBM audit report, and in so doing take a step toward restoring balance and workability to Virginia’s Medicaid program.