Pharmacy group cheers Ohio's new PBM-reform law

The Senior Care Pharmacy Coalition (SCPC) praised Ohio Gov. John Kasich on Tuesday for signing into law a legislative effort to help pull back the curtain on pharmacy-benefit manager (PBM) drug pricing and reimbursement practices.

"We applaud Governor Kasich for bringing badly needed reform to secretive and opaque PBM drug pricing and reimbursement practices, and doing so will benefit patients and taxpayers in Ohio," SCPC President and CEO Alan Rosenbloom said.

PBMs use maximum allowable cost (MAC) pricing and other practices under Medicare Part D, which is by far the most significant payer for prescription medications in long-term care settings, such as skilled nursing facilities and assisted-living facilities. Similar to Ohio, MAC pricing and related practices under Part D result in underpayments to pharmacies -- especially long-term-care pharmacies.

An analysis by the Ohio Pharmacists Association said PBM reforms are meant to rein in underpayments to pharmacies by insurers and PBMs. Specifically, the bill would require PBMs to update their MAC price lists at a minimum of every seven days, among other requirements.

"The bottom line is that legislative and regulatory action reforming MAC pricing will have a positive public policy impact on LTC (long-term care) pharmacies' ability to improve patient outcomes, reduce re-hospitalizations and save Medicare dollars," Rosenbloom said.