Prescription drugs

Opiate settlement could mean $1B for Ohio treatment, prevention programs

Ohio and other states reached a $26 billion settlement with the three largest drug distributors as well as manufacturer Johnson & Johnson that is expected to surge cash into opioid treatment and prevention programs (Source: “Ohio could get $1B from multibillion dollar deal with opiate maker and three distributors,” Columbus Dispatch, July 21).

Ohio's cut of the cash could hit $1.03 billion if local jurisdictions sign onto the agreement, according to Ohio Attorney General Dave Yost's office.

The agreement comes after nearly four years of negotiations. Under the settlement, J&J will pay up to $5 billion over nine years and the three distributors — McKesson Corp., AmerisourceBergen and Ohio-based Cardinal Health Inc. — will collectively pay up to $21 billion over 17 years. 

In March 2020, Yost and Gov. Mike DeWine announced that local governments had signed off on a plan on how opioid settlement money would be divvied up. The OneOhio agreement calls for 30% of the money to be earmarked for community recovery programs at the local level, 55% for a statewide foundation and 15% to the state.

ODM hires PBM watchdog

The Ohio Department of Medicaid completed its revamp of the pharmacy benefit manager program Wednesday by awarding a contract to a company that will serve as a watchdog (Source: “As part of revamp, Ohio Medicaid hires watchdog for state-run pharmacy benefits manager,” Columbus Dispatch, April 14).

Indianapolis firm Myers and Stauffer will be paid an average of $1.5 million a year under a two-year pact that has an additional six optional years. The price tag if the deal remains in place for the entire eight years would be $12 million.

The new firm — which already manages the National Average Drug Acquisition Cost database for the federal government — essentially will act as a watchdog on a state-run PBM.

The restructuring is expected to take effect in early January. It replaces a setup that has Medicaid-hired managed-care organizations hire the pharmacy benefit managers, which act as middlemen in the drug supply chain.

Federal officials ask pharmacists to help boost childhood immunization rates

Federal officials are asking pharmacists to undergo additional training to help reverse the slump in child immunization rates caused by the coronavirus pandemic (Source: “Feds Look to Pharmacists to Boost Childhood Immunization Rates,” Kaiser Health News, Dec. 3).

Fears over COVID-19 have led parents to avoid the doctor’s office and pediatricians to curtail in-person care. As a result, many children are missing routine vaccinations.

In August, the Department of Health and Human Services took steps to override restrictions in many states that kept state-licensed pharmacists from immunizing children. However, challenges remain in getting pharmacists fully integrated into the nation’s framework of childhood vaccinations, immunization experts said.

A key issue is that few pharmacists participate in the Vaccines for Children program, a federal initiative that purchases vaccines for the nation’s neediest kids. Half of children in the U.S. receive immunizations through the program, which purchases government-recommended vaccines for kids ages 0 to 18 who are low-income, uninsured or belong to an indigenous group. Compared with last year, VFC-funded orders for vaccines overall are down 9.6 million doses as of Nov. 9, said a spokesperson from the Centers for Disease Control and Prevention. Measles-containing vaccines are down an estimated 1.3 million doses.

Without solving the issues that keep pharmacists from participating in the Vaccines for Children program, said Claire Hannan, executive director of the Association of Immunization Managers, the steps to give parents more access to immunizations through drugstores may ultimately help only Americans wealthy enough to use it.

Ohio prescription drug tracking system most-utilized in U.S.

Use of the Ohio system tracking prescriptions for controlled substances has reached record levels, Gov. Mike DeWine and State of Ohio Board of Pharmacy Executive Director Steven Schierholt announced last week (Source: “Use of Ohio’s prescription tracking program hits record high,” Portsmouth Daily Times, Aug. 5, 2019).

The Ohio Automated Rx Reporting System (OARRS,) operated by the State of Ohio Board of Pharmacy, allows doctors and pharmacists to access patients’ controlled substance prescription history to help detect prescription drug abuse and intervene with high-risk patients.

Use of OARRS recently surpassed 1 million daily queries on two separate occasions, a milestone which, according to data from the American Medical Association, ranks OARRS as the most utilized prescription drug monitoring program in the country.

According to the state board of pharmacy, the number of individuals engaged in doctor shopping decreased by 89 percent between 2011 to 2018 and the total number of opioid prescriptions decreased by 4.6 million between 2012 and 2018.

Ohio OKs first marijuana testing lab

Ohio gave the first certificate of operation to a medical marijuana testing facility this week, which means that every level — cultivation, processing, testing and dispensing — now has at least one business ready to serve the state’s medical marijuana customers  (Source: “Ohio gives green light to first marijuana testing lab,” Columbus Dispatch, Dec. 20, 2018).

North Coast Testing Laboratories, of Streetsboro in Portage County, can begin testing cannabis samples. Just a few of the small growers have cannabis ready for testing, so the first product to reach consumers will be very limited.

Ohio hopes to see its first medical marijuana sale sometime around Jan. 1.

At least 2,170 Ohioans hold active medical marijuana cards now, and doctors have written more than 3,460 recommendations for medical marijuana, according to Ohio’s Board of Pharmacy.

The Health Policy Institute of Ohio has created an online resource page to inform policymakers and other stakeholders about the Medical Marijuana Control Program and medical marijuana legalization in Ohio. The resource page also includes resources on the health and policy implications of changes in marijuana use.

Ohio legislators consider bill to end ‘step therapy’ for prescription drugs

Lawmakers are pushing measures that would enable patients to obtain medicine that their insurers wouldn’t normally cover unless they tried cheaper drugs first and were unsuccessful (Source: “Ohio bills would make it easier for patients to get more costly meds,” Cleveland Plain Dealer, Nov. 13, 2018).

With only weeks left before the General Assembly session ends, the bipartisan sponsors of Senate Bill 56 and House Bill 72 -- which are identical -- hope that one of the bills prevails. Sixty patient and physician groups back the effort to regulate what managed care organizations call “step therapy,” since patients begin with the most cost-effective and widely proven drug and progress to more expensive and riskier drugs only when the cheaper ones are unsuccessful.

Health insurers, however, oppose the legislation. They note patients are grouped together in insurance pools, and the costs of the more expensive drugs will be passed on to everyone if the legislation passes. Prescriptions currently account for 23 cents of each dollar people pay on their premiums. Ohio Medicaid has cautioned the legislation could cost the state tens of millions of dollars a year.

“The insurance plans have been the primary and virtually sole opponent,” said sponsor Sen. Peggy Lehner, a Dayton-area Republican. “Medicaid hasn’t taken a position against it but they have expressed concerns. One of those are the costs that might be incurred."

However, 18 states have already passed similar “patient protection laws” on step therapy and none have reported major price hikes, Lehner said.

Cordray, DeWine back Medicaid pharmacy reforms

A major reform to the way the Ohio Department of Medicaid buys billions of dollars worth of prescription drugs seems likely to continue regardless of who wins the governor's race Nov. 6 (Source: “Richard Cordray, Mike DeWine back state Medicaid reform on prescription-drug middlemen,” Columbus Dispatch, Oct. 22, 2018).

The department announced in August that it would tell the state's five Medicaid managed-care plans to update their contracts with pharmacy middlemen that allowed the middlemen to charge taxpayers $224 million a year more than they were paying pharmacies for prescription drugs. The Medicaid department conducted its investigation after The Dispatch used confidential pharmacy data to conduct its own analysis that showed somewhat higher markups.

The Medicaid department's revamp require managed-care companies to move on Jan. 1 from the current "spread pricing" model to a "pass-through" model, under which pharmacy middlemen will be paid a straight administrative fee and forced to bill the state the same amount they pay pharmacists.

Some medical marijuana could hit the market in Ohio next month

The first batches of legal medical marijuana may be available in Ohio as early as mid-November but the initial supply is expected to sell out almost immediately, according to state officials (Source: “Legal medical marijuana may be available in Ohio next month,” Springfield News-Sun, Oct. 4, 2018)

Mark Hamlin of the Ohio Department of Commerce said this week that two small-scale cultivators — one in Meigs County and another in Portage County — will have product ready for state inspection in early November.

Hamlin told the Medical Marijuana Advisory Committee that the first batches will serve hundreds, not thousands, of patients. Likely, Ohio will see what played out in the early days in other states: a handful of dispensaries open, sell out in a matter of days, close again until more product is available, Hamlin said.

Board of Pharmacy rules cannabis byproducts can’t be sold in Ohio stores

The Ohio Board of Pharmacy said, in a ruling posted on its website this week, that products that contain cannabidiol (CBD), a chemical found in cannabis plants, are not legal in Ohio (Source: “Ohio Pharmacy Board: No cannabis products can be sold in stores,” Canton Repository, Aug. 31, 2018).

On the shelves of stores throughout Ohio are whole hemp sections with products that contain CBD, such as hemp honey, CBD oils and skin creams. In Ohio, now that medical marijuana is legal, nothing extracted or clipped from a cannabis plant can be bought, sold or owned unless it comes from one of the 56 licensed dispensaries spread throughout the state.

All cannabis products also have to comply with other rules handed down by the legislation that legalized medical marijuana. That means any product derived from cannabis must have a “known source” and show the quantities of active ingredients. The products must also be tested by a state-approved lab.

Report finds Medicaid pharmacy benefit managers charging triple the going rate

A study commissioned by Medicaid officials found that pharmacy benefit managers are charging Ohio's Medicaid program three times the recommended rate (Source: “Drug middlemen charging Ohioans triple the going rate — or more,” Columbus Dispatch, June 27, 2018).

According to the study, CVS Caremark billed the state about $5.60 per script, while Optum Rx charged $6.50 per script, yet the report released last week said the “fees should be in the range of 95 cents to $1.90 per prescription.” 

That means that Ohio Medicaid’s two pharmacy benefit managers, known as PBMs, received as much as $187 million above the typical cost of administering such programs in one year — $130 million to $164 million more for CVS Caremark and $19 million to $23 million for Optum Rx.

Last week, Medicaid officials announced the results of what is believed to be the first attempt by any state to determine “spread pricing,” or the difference between how much pharmacy benefit managers are billing the state and what they are reimbursing pharmacists to fill prescriptions. It found that PBMs made $223.7 million to process nearly 40 million prescriptions from April 1, 2017, through March 31, 2018.

Meanwhile, the Ohio House on Wednesday took aim at PBMs, unanimously approving bipartisan legislation aimed at increasing transparency of drug prices and lowering prescription costs. House Bill 479, sponsored by Reps. Scott Lipps, R-Franklin, and Thomas E. West, D-Canton, would prohibit health insurers and PBMs from charging consumers co-pays amounting to more than they would pay if the drugs were purchased without insurance or more than the pharmacy was being reimbursed to fill a prescription.

It would also ban “gag rules” that prevent pharmacists from telling their customers about cheaper options for acquiring medications, such as paying out of pocket.