Last week, the Wall Street Journal (WSJ) reported on investigations and audits by several states into the contractual relationships with pharmacy benefit managers, also known as PBMs. As noted in the article, state Medicaid programs are taking a closer look at their PBM contractors’ compliance practices, both contract and regulatory, to determine whether the PBMs received any potential overpayments.  According to the WSJ, certain states—including Ohio, Mississippi, Arkansas, Kansas, Georgia and New Mexico—have hired outside legal counsel to assist in the investigation. The current investigations could have significant implications for the state healthcare programs and Medicaid PBMs moving forward.  One state attorney general quoted in the article notes that other states are examining their relationships with PBMs and the number of states bringing complaints against PBMs may increase.

 

The full WSJ article (subscription required) is available here.