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Ohioans should
pay
no more than is absolutely necessary for
their medicines.

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IT'S TIME TO MAKE OUR HEALTHCARE SYSTEM WORK FOR OHIO TAXPAYERS AND CONSUMERS.

IT'S TIME FOR THE 

PBM ACCOUNTABILITY PROJECT.

ABOUT US

While the pace of medical innovation has yielded unprecedented advances in how we treat – and even cure – many serious diseases, the price and actual costs of prescription medicines for patients and purchasers have remained largely a mystery.

 

The PBM Accountability Project of Ohio brings together leaders across the state to help ensure that Ohioans aren’t overpaying for the prescription medicines they need. We are working to improve the understanding of the Pharmacy Benefit Managers' — or “PBMs” — process for determining the cost of medicines, and find solutions to help redirect savings to patients, employee health plans, and state taxpayers.

 

PBMs have asserted that they were created to increase the bargaining power of patients and purchasers in negotiating prices for prescription medicines. However, recent investigations by local journalists and audits by state officials have revealed that PBMs have been the ones profiting at the expense of Ohioans. Today, as controversy over PBM pricing schemes swells and litigation against PBM pricing practices continues in our state, we believe that the time for meaningful reform has come.

 

The mission of the PBM Accountability Project of Ohio is to assure that the prescription drug savings PBMs capture are actually passed through to Ohioans who need and deserve them, rather than being diverted into excessive profits of PBMs.

Partners

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Easter Seals - Central & Southeast Ohio.
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about us

PRESCRIPTION DRUG PRICING AND PBMs

As large companies that act as middlemen between prescription drug manufacturers, public and private sector health plans, and pharmacies that ultimately sell prescription drugs to patients, PBMs are heavily involved in the drug pricing process. 

PBMs determine:

  • the prescription drug benefit for public and private health insurers;

  • which drugs will be covered by insurance plans, making lists of allowed drugs called “formularies”;

  • where a patient can – and cannot – obtain their medications;

  • the reimbursement rates paid to pharmacies for filling prescriptions; and

  • the rates charged to employers and government payers.
     

The Columbus Dispatch “Side Effects” series highlights some of the many issues in our state.

about pbms

Our Principles

We are committed to finding meaningful reforms in the drug pricing system to minimize waste and to ensure Ohio patients, families, and communities can afford their medications.

Together, we are:

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providing resources to educate stakeholders

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presenting effective,

patient-oriented solutions

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effecting change for the benefit of Ohio patients, taxpayers, public and private sector purchasers of prescription medicines

Together, we believe:

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PBMs should compete transparently

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The lion's share of financial savings should flow directly to Ohio patients, health plan beneficiaries, and taxpayers.

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PBMs should be accountable for delivering the highest possible savings - the most affordable prescription drug pricing - to Ohio group purchasers and individual patients. 

Savings Should Be Directed to Ohio Patients, Businesses, & Taxpayers:

Patients Currently Pay More

The PBM system was adopted to help determine affordable prices for prescription medicines and ensure that patients have affordable access through insurance plans. Savings negotiated by PBMs with drug manufacturers should be flowing to reduce patient out-of-pocket costs, but PBMs are keeping these savings for themselves.

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PBMs Exploit the State of Ohio and its Independent Pharmacists

Some local independent pharmacies have been forced out of business because PBMs often reimburse pharmacists less than what it costs to fill a prescription. At the same time, Ohio is being overcharged by PBMs.

 

Investigators have found that while PBMs were shortchanging local pharmacies in Ohio, the PBMs turned around and overcharged Ohio Medicaid by more than $240 million.

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PBMs are Keeping Employers in the Dark

PBM contracts with employers are often overly complicated, ambiguously worded, and often benefit the PBM at the expense of the employer. One study shows that three in five employers think their contracts with PBMs are problematic.

Case Studies

States have made significant changes to the way they work with PBMs, creating a groundbreaking competitive marketplace for contracting of prescription drug benefits. The online reverse auction model has enabled states to reduce spending on prescription medicines, without any reduction in benefits, including:

NEW JERSEY

New Jersey saved an unprecedented
$2.5 billion over five years

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NEW HAMPSHIRE

New Hampshire is expected to save
as much as

$22 million
annually

MINNESOTA

Minnesota is projected to save more than $28 million in drug costs in 2023 and 2024

COLORADO

Colorado is expected to save between $6 million and $10 million annually

OHIO

Ohio has passed legislation and is awaiting implementation of the reverse auction to secure prescription drug savings.

We're finding solutions to: 

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Effectively drive down prescriptions drug costs

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Ensure Ohioans still have access to the providers and medicines they need

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Respect Ohio taxpayers and save money for families and communities

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Address budget issues our state faces due to the pandemic 

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