The Ohio Department of Medicaid published a report evaluating the single PBM reform program mandated by H.B. 166 from 2019 and implemented on Oct. 1, 2022. Single PBM programs look to enhance cost efficiency, improve medication adherence, and provide more coordinated care in managed Medicaid programs. For Ohio pharmacies, this also entailed reimbursement using the state Medicaid program’s fee-for-service reimbursement methodology. The report found a total savings of $140 million during the first two years of the single PBM program, even after the average professional dispensing fee shifted from $0.73 to around $9 per the fee-for-service methodology.
The report found these changes stabilized the Medicaid marketplace, preserving and even expanding patient access. It demonstrates that PBM and Medicaid reforms using transparent cost-based reimbursement models such as NADAC plus a professional dispensing fee don’t increase costs; on the contrary, they can save money for employers, insurers, and taxpayers.
