UnitedHealth, CVS Health head to court to protect PBM information: 5 things to know

UnitedHealth and CVS Health pharmacy benefit managers are battling with the state of Ohio over efforts to reveal information tied to Medicaid contracts that the state believes should be — and in some cases, already is — public knowledge. 

Here are five things to know:

1. The conflict between the state's Medicaid program, CVS Caremark and OptumRx, and pharmacies arose in 2017 when pharmacies claimed that the two pharmacy benefit managers were driving them out of business with low rates. Then-Gov. John Kasich helmed an inquiry into reimbursement rates and hired a third party to craft a report on it in 2018.

2. A heavily redacted version of the 2018 report was made public and brought to light reimbursement charges that cost Ohio $224 million in overcharges that were three times the going rate. 

3. CVS Caremark and OptumRx, who manage 80 percent and 20 percent, respectively, of prescription drug benefits for Ohio's five Medicaid managed-care plans, are now fighting to keep an unredacted version of the 2018 report on reimbursement information secret, according to the Ohio Capital Journal

4. However, some information from the full report was made public by The Columbus Dispatch in 2019. This includes claims that CVS Caremark used its Medicaid relationship to reimburse large companies far less than it reimbursed its own stores. 

5. The pharmacy benefit managers are now suing to keep the full report's documents under seal, despite some of the information already being released. The trial against the Ohio Department of Medicaid goes to the Franklin County Court of Common Pleas Sept. 9.

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