Medicaid cost? Ohio can look toward West Virginia
In 2017, West Virginia was faced with growing Medicaid costs — particularly when it came to prescription drugs. So state government cut out the middlemen, pharmacy benefit managers, and turned to a streamlined system that utilizes West Virginia University’s School of Pharmacy to recommend drugs for patients, instead. The move saved the Mountain State $30 million in its first year.
Now Ohio is struggling under the $2.5 billion its Medicaid system must spend on prescription drugs, through its managed-care plans. State officials are looking for a solution. They may not have to look any farther than across the Ohio River.
At WVU, there are “clinical, well-informed individuals who make appropriate clinical decisions,” according to a report in the Columbus Dispatch, and they are interested in the best health outcomes, not corporate profits.
Of course, there is resistance to this idea from the pharmacy benefit managers, who have had the luxury of operating in a remarkably layered and opaque environment. One tactic is pointing out that Ohio has a much larger population than West Virginia’s.
True, the system in place in West Virginia would have to be scaled up. Dr. Robert Weber, chief pharmacist and assistant dean for medical center affairs at Ohio State, acknowledges there would have to be an increase in resources to duplicate the Mountain State model. But it is possible.
“Our committee is focused on how we can improve quality of care,” Weber told the Dispatch. “We do not have any influence from the drug industry, no significant conflict of interests, we do not allow manufacturers to come into the institution, and the cost of the drug is the last thing we consider.”
Vicki Cunningham, West Virginia Medicaid’s director of pharmacy services, agrees Ohio could take advantage of West Virginia’s model. “You have to provide the same things if you have one person or 100,000,” she said.
There are, as is always the case when bureaucrats dig in, other factors. Ohio might also need to look at unbundling other services provided by the benefit managers to provide greater transparency (which almost always leads to saving more money). West Virginia has done that, too.
Assuming careful analysis of the plan shows the West Virginia model can be scaled up and will save Ohioans money, Ohio’s Department of Medicaid should consider following the Mountain State’s lead.